Kidney Week

Abstract: TH-OR055

Reduced Kidney Function Is Associated with a Greater Burden of Atrial Fibrillation: The KP-RHYTHM Study

Session Information

• CKD: Clinical, Outcomes, and Trials
  November 07, 2019 | Location: 202, Walter E. Washington Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: CKD (Non-Dialysis)

• 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States

Alan S. Go, MD



Dr. Alan S. Go is a General Internist who is the Regional Medical Director of Clinical Trials, Chief of Cardiovascular and Metabolic Conditions Research, and Director of the Solutions Through Technology and Advanced Analytic Research (STAR) Group at the Kaiser Permanente Northern California Division of Research. He is also Professor of Epidemiology, Biostatistics and Medicine (Nephrology) at UCSF and Consulting Professor of Medicine, Health Research and Policy at Stanford University. Dr. Go is a Principal Investigator for the NIDDK-sponsored Chronic Renal Insufficiency Cohort (CRIC) Study as well as a Principal Investigator for the NIDDK-sponsored Assessment, Serial Evaluation and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study. Dr. Go is an internationally-recognized researcher and clinical trialist in kidney and cardiovascular disease, along with developing and implementing methods for large-scale research leveraging electronic health records and mobile health technologies, as well as implementing traditional and clinical trials in healthcare delivery systems.

• Yang, Jingrong, Kaiser Permanente Northern California, Oakland, California, United States

Jingrong Yang,

• Reynolds, Kristi, Kaiser Permanente Southern California, Pasadena, California, United States

Kristi Reynolds,

• Gupta, Nigel, Kaiser Permanente Southern California, Pasadena, California, United States

Nigel Gupta,

• Lenane, Judith C., iRhythm Technologies, Inc., San Francisco, California, United States

Judith C. Lenane,

• Garcia, Elisha, Kaiser Permanente Northern California, Oakland, California, United States

Elisha Garcia,

• Sung, Sue hee, Kaiser Permanente Northern California, Oakland, California, United States

Sue hee Sung,

• Harrison, Teresa N., Kaiser Permanente Southern California, Pasadena, California, United States

Teresa N. Harrison,

• Solomon, Matthew, Kaiser Permanente Northern California, Oakland, California, United States

Matthew Solomon,

Background

Atrial fibrillation (AF) is the most potent risk factor for ischemic stroke. Previous studies have reported that reduced kidney function is associated with a higher risk of developing AF. Having a greater burden of AF (i.e., amount of time spent in AF is also an independent risk factor for stroke However, whether kidney function influences the burden of AF is unclear.

Methods

The Kaiser Permanente (KP) RHYTHM Study included all adult members of KP Northern and Southern California integrated healthcare delivery systems who underwent 14-day continuous, beat-to-beat ambulatory ECG monitoring using the ZIO^® XT Patch between October 2011-October 2016. We identified patients who had known estimated glomerular filtration rate (eGFR) by CKD-EPI within the year before monitoring, who were not receiving renal replacement therapy, and who had AF detected during the monitoring period. Patient demographic characteristics and stroke risk factors were obtained from electronic health records. We examined the multivariable association of log-transformed AF burden (% analyzable wear time spent in AF) per 10 mL/min/1.73 m² decrease in eGFR.

Results

Among 1069 eligible adults with detected AF on continuous ambulatory monitoring, mean age was 69.1 years, 45% were women, and 25% were persons of color. Overall, median AF burden was 4% (IQR:1% to 13%). After adjustment for proteinuria, age, gender, race/ethnicity, heart failure, hypertension, diabetes mellitus, and prior stroke/transient ischemic attack, every 10 mL/min/1.73m² lower level of eGFR was independently associated with a 10% higher burden of AF (adjusted relative estimate 9.7%, 95% CI:1.1%-19.0%).

Conclusion

Among adults found to have AF on 14-day continuous ambulatory ECG monitoring, lower eGFR level was independently associated with a higher burden of AF. Reduced kidney function may contribute to excess risk of stroke through promoting both a higher incidence of developing AF as well as a greater burden of AF.

Funding

• Commercial Support – iRhythm Technologies