Abstract
Patients with atrial fibrillation (AF) have elevated risks of developing stroke, heart failure, and myocardial infarction. However, the impact of AF on the progression of chronic kidney disease (CKD) is uncertain. Our review objective is to investigate whether AF increases the risk of developing end-stage renal disease (ESRD) in patients with CKD. On 31 January 2019, a systemic search was performed on the MEDLINE database using the predefined search criteria. Limits included human participants and English-language publications. Studies that evaluated an association of AF and the risk of CKD progression to ESRD were selected. A total of 751 articles were identified. One prospective cohort study was included after screening abstracts from overall retrieved studies based on our inclusion/exclusion criteria, with a total of 3,091 CKD patients and a mean follow-up of 5.9 years. A total of 172 CKD patients developed AF, of which 43 patients later developed ESRD. Of 2,919 CKD patients with no incident AF, 581 patients progressed to ESRD. The rate of ESRD after the development of AF was 11.8/100 person-years compared with 3.4/100 person-years in CKD patients without AF. In conclusion, AF is an independent risk factor for developing ESRD in CKD patients, but more evidence is needed to support this result.
Highlights
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia with more than five million incident cases worldwide [1]
Studies that evaluated an association of atrial fibrillation (AF) and the risk of chronic kidney disease (CKD) progression to end-stage renal disease (ESRD) were included
Of 2,919 CKD patients with no incident AF, 581 patients progressed to ESRD
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with more than five million incident cases worldwide [1]. AF, atrial fibrillation; CKD,chronic kidney disease; ESRD, end-stage renal disease; LV, left ventricular. The authors conducted marginal structural models for the multivariable association of incident AF with the risk of ESRD among subgroups with CKD, it is not comprehensive with lack of several important factors such as smoking status, duration, and severity of diabetes mellitus, and HIV status. Another weakness is the generalizability to the general population as the study was conducted on research volunteers in only one country. The evidence is based on only one single study so that there is a need to conduct more research evaluating the effect of AF in CKD progression, ideally prospective, multicenter with large sample sizes and addressed all significant multivariable association
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