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2017 ; 6
(7
): ä Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Association of Proteinuria and Incident Atrial Fibrillation in Patients With
Intact and Reduced Kidney Function
#MMPMID28684642
Molnar AO
; Eddeen AB
; Ducharme R
; Garg AX
; Harel Z
; McCallum MK
; Perl J
; Wald R
; Zimmerman D
; Sood MM
J Am Heart Assoc
2017[Jul]; 6
(7
): ä PMID28684642
show ga
BACKGROUND: Early evidence suggests proteinuria is independently associated with
incident atrial fibrillation (AF). We sought to investigate whether the
association of proteinuria with incident AF is altered by kidney function.
METHODS AND RESULTS: Retrospective cohort study using administrative healthcare
databases in Ontario, Canada (2002-2015). A total of 736 666 patients aged
?40 years not receiving dialysis and with no previous history of AF were
included. Proteinuria was defined using the urine albumin-to-creatinine ratio
(ACR) and kidney function by the estimated glomerular filtration rate (eGFR). The
primary outcome was time to AF. Cox proportional models were used to determine
the hazard ratio for AF censored for death, dialysis, kidney transplant, or end
of follow-up. Fine and Grey models were used to determine the subdistribution
hazard ratio for AF, with death as a competing event. Median follow-up was
6 years and 44 809 patients developed AF. In adjusted models, ACR and eGFR were
associated with AF (P<0.0001). The association of proteinuria with AF differed
based on kidney function (ACR × eGFR interaction, P<0.0001). Overt proteinuria
(ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact
(eGFR, 120) versus reduced (eGFR, 30) kidney function (adjusted hazard ratios,
4.5 [95% CI, 4.0-5.1] and 2.6 [95% CI, 2.4-2.8], respectively; referent ACR 0 and
eGFR 120). Results were similar in competing risk analyses. CONCLUSIONS:
Proteinuria increases the risk of incident AF markedly in patients with intact
kidney function compared with those with decreased kidney function. Screening and
preventative strategies should consider proteinuria as an independent risk factor
for AF.
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