Chronic kidney disease is associated with the incidence of atrial fibrillation: The atherosclerosis risk in communities (ARIC) Study

Background-: Chronic kidney disease is associated with the incidence of cardiovascular disease. Chronic kidney disease may also increase the risk of atrial fibrillation (AF), but existing studies have reported inconsistent results. Methods and results-: We estimated cystatin C-based glomerular filtration rate (eGFRcys) and measured urinary albumin-to-creatinine ratio (ACR) in 10 328 men and women free of AF from the Atherosclerosis Risk in Communities (ARIC) Study in 1996 to 1998. Incidence of AF was ascertained through the end of 2007. During a median follow-up of 10.1 years, we identified 788 incident AF cases. Compared with individuals with eGFRcys 90 mL • min • 1.73 m, multivariable hazard ratios and 95% confidence intervals (CIs) of AF were 1.3 (95% CI, 1.1 to 1.6), 1.6 (95% CI, 1.3 to 2.1), and 3.2 (95% CI, 2.0 to 5.0; P for trend <0.0001) in those with eGFRcys of 60 to 89, 30 to 59, and 15 to 29 mL • min • 1.73 m, respectively. Similarly, the presence of macroalbuminuria (ACR 300 mg/g; hazard ratio, 3.2; 95% CI, 2.3 to 4.5) and microalbuminuria (ACR, 30 to 299 mg/g; hazard ratio, 2.0; 95% CI, 1.6 to 2.4) was associated with higher AF risk compared with those with ACR <30 mg/g. Risk of AF was particularly elevated in those with both low eGFRcys and macroalbuminuria (hazard ratio, 13.1; 95% CI, 6.0 to 28.6, comparing individuals with ACR 300 mg/g and eGFRcys of 15 to 29 mL • min • 1.73 m and those with ACR <30 mg/g and eGFRcys 90 mL • min • 1.73 m). Conclusion-: In this large population-based study, reduced kidney function and presence of albuminuria were strongly associated with the incidence of AF independently of other risk factors.