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Abstract: TH-PO872

Lower Glomerular Filtration Rate and Higher Albuminuria Are Associated With Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Ha, Jeffrey, The George Institute for Global Health, Newtown, New South Wales, Australia
  • Freedman, Ben, Heart Research Institute Ltd, Newtown, New South Wales, Australia
  • Kelly, Dearbhla M., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Neuen, Brendon Lange, The George Institute for Global Health, Newtown, New South Wales, Australia
  • Perkovic, Vlado, University of New South Wales, Sydney, New South Wales, Australia
  • Jun, Min, The George Institute for Global Health, Newtown, New South Wales, Australia
  • Badve, Sunil, The George Institute for Global Health, Newtown, New South Wales, Australia
Background

In patients with atrial fibrillation (AF), the risk of stroke and mortality increases with worsening estimated glomerular filtration rate (eGFR). The purpose of this systematic review was to study the independent associations of eGFR and albuminuria with incident AF.

Methods

MEDLINE, EMBASE and CENTRAL databases were searched for cohort studies and randomized controlled trials that reported incident AF in adults according to baseline measurements of eGFR or albuminuria. From cohort studies, multivariable-adjusted risk ratios (RR) were extracted. For each trial, RRs and 95% CIs for eGFR and albuminuria categories were derived from meta-analysis using reported event data. The outcome of incident AF was analyzed separately among patients with decreased eGFR and increased albuminuria using random effects meta-analysis. If studies reported more than one estimate of the association for different eGFR and albuminuria categories, a within-study summary risk estimate was obtained. Subgroup analyses according to eGFR and albuminuria categories were conducted to explore sources of heterogeneity.

Results

Thirty-five studies involving 26,840,893 participants with 436,304 incident AF cases were included. Compared to participants with eGFR ≥60 and ≥90 mL/min/1.73 m2, the risk of incident AF was increased among participants with eGFR ≤59 mL/min/1.73m2 (16 studies, RR 1.56, 95% CI 1.34 – 1.81, I2= 70%), and eGFR ≤89 mL/min/1.73m2 (11 studies, RR 1.49, 95% CI 1.28 – 1.74, I2=67%), respectively. Compared to participants with no albuminuria, the risk of incident AF was greater among participants with albuminuria (3 studies, RR 1.37, 95% CI 1.18 – 1.60, I2=0%). Compared to those with normal to mildly increased albuminuria, risk of incident AF was greater for participants with moderately- to severely-increased albuminuria (6 studies, RR 1.67, 95% CI 1.28 – 2.17, I2=75%). Subgroup analyses showed that incident AF risk increased progressively at lower eGFR and higher albuminuria categories.

Conclusion

Lower eGFR and higher albuminuria are independent risk factors for incident AF. Additional studies are required to evaluate whether systematic screening for AF leads to improved outcomes in patients with chronic kidney disease.