Kidney Week

Abstract: PO2358

Bidirectional Association Between Kidney Function and Atrial Fibrillation in the General Population

Session Information

• Reassessing Race in Predicting Progression
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• van der Burgh, Anna C., Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Anna C. van der Burgh

• Geurts, Sven, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Sven Geurts,

• Ikram, M. Arfan, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

M. Arfan Ikram,

• Hoorn, Ewout J., Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Ewout J. Hoorn,

• Kavousi, Maryam, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Maryam Kavousi,

• Chaker, Layal, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Layal Chaker,

Background

A potential bidirectional relationship between kidney dysfunction and atrial fibrillation (AF) has been suggested, but has not been studied in the general population. Therefore, we aimed to study the association of different assessments of kidney function with prevalent and incident AF in the general population.

Methods

Participants aged ≥ 45 years from the Rotterdam Study, a population-based cohort study, with information on kidney function and AF were included. Assessments of kidney function included single assessments of estimated glomerular filtration rate (eGFR) based on serum creatinine (eGFRcreat), serum cystatine C (eGFRcys), or both (eGFRcreat-cys), and the urine albumin-to-creatinine ratio (ACR), and repeated assessments of eGFRcreat. Incident chronic kidney disease (CKD) was defined as the first time eGFRcreat dropped <60 ml/min per 1.73 m². Cox-proportional hazards, logistic regression, linear mixed, and joint models were used to investigate the associations of eGFR with incident and prevalent AF. Absolute 10-year risk of AF was computed using a competing risk analysis. All models were adjusted for potential confounders including cardiovascular risk factors.

Results

During a median follow-up time of 8.0 years, 780 incident AF cases occurred in 9,288 participants (mean age 64.9 years, 57.2% female). Lower eGFRcys and eGFRcreat-cys were significantly associated with an increased risk of incident AF (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.03-1.14 and HR 1.07, 95% CI 1.01-1.14, respectively, per 10 ml/min per 1.73 m² decrease in eGFR), while eGFRcreat was not. No association between urine ACR and incident AF was found. Absolute 10-year risk of developing AF increased from 4.9% to 7.1%, when comparing eGFRcys levels of 90 to 60 ml/min per 1.73 m². Prevalent AF (409 cases) was associated with on average 2.85 ml/min per 1.73 m² lower eGFRcreat levels over time and furthermore, a faster decline of eGFRcreat with aging was revealed when compared to participants without prevalent AF. Prevalent AF was also associated with a 1.3 fold increased risk of incident CKD.

Conclusion

Kidney function and AF are bidirectionally associated. This insight may be used to improve prediction and prevention of both conditions, for example through targeted screening programs in the general population.