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Sci Rep. 2019;9(1):18055.

Fluctuating renal function and the risk of incident atrial fibrillation: a nationwide population-based study.

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제1저자 권순일, 이소령 · 교신저자 최의근

PMID 31792292 PMC6889358 DOI 10.1038/s41598-019-54528-w IF 4.9 순환기내과
소속 (6)
  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
  2. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. choiek17@snu.ac.kr.
  3. Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
  4. Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul, Republic of Korea.
  5. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom.
  6. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

Although chronic kidney disease is known to increase the risk of atrial fibrillation (AF), the impact of the variability of renal function on the risk of incident AF is unknown. We aimed to evaluate the association between variability of renal function and the risk of developing AF among the general population. We evaluated a total of 3,551,249 adults who had three annual health check-ups provided by the National Health Insurance Service. The variability of renal function was defined as GFR-VIM, which is variability independent of the mean (VIM) of creatinine-based estimated glomerular filtration rate (eGFR). The study population was divided into four groups (Q1-4) based on the quartiles of GFR-VIM, and the risks of incident AF by each group were compared. During a mean of 3.2 ± 0.5 years follow-up, incident AF occurred in 15,008 (0.42%) subjects. The incidence rates of AF increased from Q1 to Q4 (0.98, 1.42, 1.27, and 1.63 per 1,000 person-years, respectively). Adjusting with multiple variables, Q4 showed an increased risk of incident AF compared to Q1 (hazard ratio (HR) 1.125, 95% confidence interval (CI) 1.071-1.181). Variability of serum creatinine or other definitions of variability showed consistent results. On subgroup analyses, Q4 in males or those with a decreasing trend of eGFR had significantly increased risks of incident AF compared to Q1 (HR 1.127, 95% CI 1.082-1.175; and HR 1.115, 95% CI 1.059-1.173, respectively). High variability of eGFR was associated with an increased risk of incident AF, particularly in males or those with decreasing trends of eGFR during follow-up.

Figures

Figure 1
Figure 1 The cumulative incidences of incident atrial fibrillation by the quartiles of GFR-VIM. Compared to the individuals with the lowest variability of renal function (Q1), those with the highest variability of renal function (Q4) had higher crude incidence rates of atrial fibrillation. Abbreviation: AF = atrial fibrillation; eGFR = estimated glomerular filtration rate calculated by MDRD equation; GFR-VIM = variability independent of mean of eGFR.
Figure 2
Figure 2 The risks of incident atrial fibrillation by the quartiles of GFR-VIM. With an adjusted model, the risk of incident AF was significantly increased in the group with the highest variability of renal function (Q4). For the individuals with a middle range of GFR-VIM (Q2 and Q3), there were no significant differences in AF risk compared to the group with the lowest variability of renal function (Q1). Abbreviation: CI = confidence interval; AF = atrial fibrillation; eGFR = estimated glomerular filtration rate calculated by MDRD equation; GFR-VIM = variability independent of mean of eGFR; HR = hazard ratio, adjusted by Model 2 (age, sex, smoking status, alcohol consumption, regular physical activity, low income level, body-mass index, hypertension, diabetes, and baseline eGFR); IR = incidence rate in 1,000 person-years.
Figure 3
Figure 3 The risks of incident atrial fibrillation by various subgroups. Most subgroup analyses showed consistency with the main results, whereas age strata, sex, and eGFR trends showed significant interactions. For the subgroups of age strata, an increasing trend for developing AF risk was observed in older subjects. Males showed a higher risk of AF in those with higher eGFR variability. Among the subgroups by eGFR trends, only the subjects with a decreased eGFR trend had a significantly higher risk of AF in those with higher eGFR variability. Abbreviation: AF = atrial fibrillation; CI = confidence interval; CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate calculated by MDRD equation; GFR-VIM = variability independent of mean of eGFR; HR = hazard ratio, adjusted by Model 2 (age, sex, smoking status, alcohol consumption, regular physical activity, low income level, body-mass index, hypertension, diabetes, and baseline eGFR); IR = incidence rate in 1,000 person-years. *Each subgroup represents the 4th quartile of GFR-VIM with a suggested condition, whereas the corresponding lower three quartiles served as a reference. †Individuals with decreased or increased eGFR trends were defined as the subgroups with the last eGFR lower or higher than 5% of the mean. Other cases were identified as maintained.
Figure 4
Figure 4 The flow chart of the study population. A total of 3,551,249 individuals were analyzed in the study. This population then categorized into the four groups by quartiles of GFR-VIM. Abbreviation: eGFR = estimated glomerular filtration rate calculated by MDRD equation; GFR-VIM = variability independent of mean of eGFR; IDMS = isotope dilution mass spectrometry; NHIS = national health insurance service.

그림 출처: PubMed Central 공개 논문 (PMC6889358)

Conflict of interest statement

E.K.C. reports modest research grant from Daiichi-Sankyo, BMS/Pfizer, and Biosense Webster. G.Y.H.L. reports consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo, speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. The remaining authors have nothing to disclose.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Scientific reports · eISSN 2045-2322
전자 출판
2019-12-02
MeSH
Adult · Aged · Atrial Fibrillation / epidemiology / etiology · Creatinine / blood / metabolism · Female · Follow-Up Studies · Glomerular Filtration Rate / physiology · Humans · Incidence · Male · Middle Aged · Proportional Hazards Models · Renal Insufficiency, Chronic / blood / complications / physiopathology · Risk Assessment / methods · Risk Factors · Sex Factors · United Kingdom / epidemiology · Young Adult
Substances
Creatinine
참고문헌
31편