Abstract
Abstract Background Chronic kidney disease (CKD) has a complicated relationship with the heart, leading to many adverse outcomes. Purpose The aim of the study was to evaluate the relationship between CKD and the incidence of atrial fibrillation (AF) and heart failure (HF) along with mortality as a competing risk in general population cohorts. Methods This study was conducted as part of the BiomarCaRE project using harmonised data from 12 population-based cohorts (n=40,212) from Europe. Cox proportional hazards models were used to determine hazard ratios (HRs) for the incidence of AF and HF in CKD and with competing mortality risk after adjusting for covariates. Results Mean age at baseline was 51.1 (standard deviation 11.9) years, and 49.3% were men. Overall, 3.5% had CKD at baseline. The rate for incident AF was 3.9 per 1000 person-years during follow-up. The HR for AF for those with CKD compared with those without was 1.23 (95% CI 1.00–1.52, p=0.0465) after adjustment for covariates. The rate for incident HF was 3.9 per 1000 person-years and the associated risk in the presence of CKD was HR 1.67 (95% CI 1.39–2.01). In subjects with CKD, N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed an association with AF, while NT-proBNP and C-reactive protein (CRP) showed an association with HF. Conclusion CKD is an independent risk factor for subsequent AF and even more so for HF. In patients with CKD, NT-proBNP was clearly associated with subsequent risk of AF. In addition to this marker, hs-CRP was also associated with risk of subsequent HF. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 7th framework programme collaborative project, grant agreement no. HEALTH-F2-2011_278913. Atrial Fibrillation and HF in CKD
Highlights
Chronic kidney disease (CKD) affects a large proportion of the adult population worldwide and is a global public health problem.[1]
Chronic kidney disease is an independent risk factor for subsequent atrial fibrillation (AF) and is even more closely associated with heart failure (HF). In these relatively young participants with CKD, NT-proBNP was strongly associated with subsequent risk of AF
For HF, in addition, elevated levels of hs-C-reactive protein at baseline were related to incident events
Summary
Chronic kidney disease (CKD) affects a large proportion of the adult population worldwide and is a global public health problem.[1] Hypertension and diabetes are among the most important risk factors for CKD and account for much of the disease burden. Various pathophysiological interactions may occur, leading to haemodynamic and cardiac structural changes These predispose to atrial fibrillation (AF) and heart failure (HF).[3] Both, AF4 and HF are associated with increased health care costs and mortality and, in combination with CKD, may complicate the disease course and worsen the risk for adverse outcomes.[5] Given the ageing population and the increase in common risk factors for CKD, AF, and HF, such as hypertension, diabetes, and obesity, the prevalence of CKD and related heart disease will increase in the future. Data from large population-based initiatives with harmonized information and centrally measured biomarkers, and low study-induced heterogeneity, may be valuable to investigate associations with sufficient power
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