Effects of Prevalent and Incident Chronic Kidney Disease on Cardiovascular Events in Patients with Atrial Fibrillation.

Lin Lin,Kor Kor,Chiu Chiu,Hsieh Hsieh

doi:10.3390/jcm8081184

Abstract

Background: Chronic kidney disease (CKD) is a well-known complication of atrial fibrillation (AF) but how the incident CKD affects the clinical outcomes amongst AF patients is not clear. Methods: Our study data were retrieved from National Health Insurance Research Data for the period from 1996 to 2013. Incident AF patients were classified as non-CKD group (n = 7272), prevalent CKD group (n = 2104), and incident CKD group (n = 1507) based on administrative codes. Patients with prevalent CKD were those participants who already had CKD ahead of the index date of AF, whereas patients with incident CKD were those who developed CKD after the index date and the remaining patients were designated as non-CKD. Multivariate-adjusted time-dependent Cox models were conducted to estimate the associations of CKD status with the outcomes of interest, including heart failure (HF), acute myocardial infarction (AMI), stroke or systemic thromboembolism, all-cause mortality, and cardiovascular (CV) mortality, expressed as hazard ratio (HR) and 95% confidence interval (CI). Results: The mean age was 70.8 ± 13.3 years, and 55.4% of the studied population were men. In Cox models, the adjusted rate of HF, AMI, all-cause mortality, and CV mortality was greater in the prevalent and incident CKD groups, ranging from 1.31-fold to 4.28-fold, compared with non-CKD group. Notably, incident CKD was associated with higher rates of HF (HR, 1.8; 95% CI, 1.67–1.93), stroke or systemic thromboembolism (HR, 1.33; 95% CI, 1.22–1.45), AMI (HR, 1.46; 95% CI, 1.25–1.71), all-cause mortality (HR, 1.76; 95% CI, 1.68–1.85), and CV mortality (HR, 2.13; 95% CI, 1.92–2.36) compared with prevalent CKD. Conclusion: The presence of CKD was associated with higher risks of subsequent adverse clinical outcomes in patients with AF. Our study was even highlighted by the finding that incident CKD was linked to higher risks of outcome events compared with prevalent CKD.

Highlights

The prevalence of chronic kidney disease (CKD) has been escalating gradually owing to the aging population and higher comorbidity burden, such as diabetes mellitus and hypertension [1]
During 2000 to 2013, a total of 10,883 participants were eligible for the study and they were classified as non-Chronic kidney disease (CKD) group (n = 7272), prevalent CKD group (n = 2104) and incident CKD group (n = 1507) (Figure 1)
Our findings are novel in that, (i) compared with non-CKD, both incident and prevalent CKD were associated with a 1.31- to 4.28-fold increased risk of heart failure (HF), acute myocardial infarction (AMI), all-cause death, and CV death after accounting for a broad range of crucial confounders that mediate the occurrence of CKD, atrial fibrillation (AF) and adverse events; (ii) regarding stroke or systemic thromboembolism, the higher risk was only seen in incident CKD but not in prevalent CKD; (iii) incident CKD had even higher risk of all the adverse events compared with prevalent CKD

Summary

Introduction

The prevalence of chronic kidney disease (CKD) has been escalating gradually owing to the aging population and higher comorbidity burden, such as diabetes mellitus and hypertension [1]. Multivariate-adjusted time-dependent Cox models were conducted to estimate the associations of CKD status with the outcomes of interest, including heart failure (HF), acute myocardial infarction (AMI), stroke or systemic thromboembolism, all-cause mortality, and cardiovascular (CV) mortality, expressed as hazard ratio (HR) and 95% confidence interval (CI). Incident CKD was associated with higher rates of HF (HR, 1.8; 95% CI, 1.67–1.93), stroke or systemic thromboembolism (HR, 1.33; 95% CI, 1.22–1.45), AMI (HR, 1.46; 95% CI, 1.25–1.71), all-cause mortality (HR, 1.76; 95% CI, 1.68–1.85), and CV mortality (HR, 2.13; 95% CI, 1.92–2.36) compared with prevalent CKD.

Methods

Results

Discussion

Conclusion