Abstract: FR-OR015

Incident Atrial Fibrillation and Risk of Subsequent Cardiovascular Events and Mortality: The CRIC Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Bansal, Nisha, Kidney Research Institute, Seattle, Washington, United States
  • Messe, Steven R., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Soliman, Elsayed Z., Wake Forest University School of Medicine, Winston Salem, North Carolina, United States
  • Townsend, Raymond R., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Xie, Dawei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Sha, Daohang, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Appel, Lawrence J., Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
  • Deo, Rajat, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Jamerson, Kenneth A., University of Michigan Health System, Ann Arbor, Michigan, United States
  • Kusek, John W., NIDDK, Bethesda, Maryland, United States
Background

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic kidney disease (CKD) and may be associated with poor clinical outcomes. We examined the association of incident AF with the risk of subsequent incident cardiovascular (CVD) events and mortality.

Methods

We studied participants enrolled in the prospective Chronic Renal Insufficiency Cohort (CRIC) Study without AF at baseline. Incident AF was identified by ECGs and physician-adjudicated hospitalizations. Outcomes included: incident heart failure (HF), myocardial infarction (MI), stroke and death after diagnosis of AF. Cox regression models (with time-updated AF) and marginal structural models (MSM, to account for time-dependent confounding) were used to examine the association of incident AF with outcomes, adjusting for demographics, clinical characteristics and ECG measures.

Results

Among 2,814 participants, 288 (9.2%) developed incident AF. During a mean (SD) follow-up of 7.0 (2.1) years, rates of HF, MI, stroke and death were higher in those who developed AF versus those who did not (Table). Cox and MSM models demonstrated that incident AF was associated with greater than 4-fold increased risk of subsequent incident HF, MI and death. Cox models also showed a significant association of incident AF with stroke (Table). These associations remained robust with additional adjustment for biomarkers of inflammation, cardiac stress and mineral metabolism as well as left ventricular mass, ejection fraction and left atrial diameter.

Conclusion

Incident AF is associated with increased risk of developing subsequent CVD and death in adults with CKD. Further study is needed to determine whether treatment of AF mitigates this risk.