Abstract: PUB140
Association of Loop Diuretic Use with Hospitalization for Atrial Fibrillation in CKD
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Ravi, Katherine Scovner, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Lefranc Torres, Armida, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Mc Causland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Atrial fibrillation (AF) is a common comorbidity among patients with advanced chronic kidney disease (CKD), where electrolyte derangements may play a causal role. While loop diuretics are frequently used for volume and blood pressure management in CKD, their relationship with incident AF remains poorly understood.
Methods
Using data from 4,672 patients without baseline AF from the Chronic Renal Insufficiency Cohort (CRIC), we used adjusted Cox regression models to explore the association of baseline loop diuretic use with hospitalization with AF and tested for differential associations according to sex, history of heart failure, and baseline eGFR. Models adjusted for demographics, cardiovascular risk factors, kidney function (eGFR), laboratory parameters (albumin, hematocrit, log urine protein), and the use of cardiovascular medications. We also explored if baseline serum potassium, magnesium, or calcium mediated the association of loop diuretic use with hospitalization for AF.
Results
The mean age was 59 ±11 years, 44% were female, and 42% were Black. Over a mean follow-up of 8.4 years, 584 participants experienced a hospitalization with AF. Baseline use of loop diuretics was associated with a 34% higher risk of hospitalization with AF (aHR 1.34, 95% CI 1.08, 1.65). There was no evidence for differential associations by sex or eGFR (P-interactions=0.45 and 0.27, respectively), but there appeared to be a stronger association among those with a prior history of heart failure (aHR 2.92; 95% CI 1.20, 7.14) compared to those without heart failure (aHR 1.25; 95% CI 1.00,1.57; P-interaction=0.05).
Conclusion
Among patients with CKD and without a history of AF, the use of loop diuretics is independently associated with subsequent hospitalization with AF. This association appeared to be more potent among those with (vs. without) a history of heart failure. The etiology of the observed association requires further investigation.
Funding
- NIDDK Support