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Atrial Fibrillation and Risk of ESRD in Adults with CKD.

Publication ,  Journal Article
Bansal, N; Xie, D; Tao, K; Chen, J; Deo, R; Horwitz, E; Hsu, C-Y; Kallem, RK; Keane, MG; Lora, CM; Raj, D; Soliman, EZ; Strauss, L; Wolf, M ...
Published in: Clin J Am Soc Nephrol
July 7, 2016

BACKGROUND AND OBJECTIVES: Atrial fibrillation frequently complicates CKD and is associated with adverse outcomes. Progression to ESRD is a major complication of CKD, but the link with atrial fibrillation has not been fully delineated. In this study, we examined the association of incident atrial fibrillation with the risk of ESRD in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied participants in the prospective Chronic Renal Insufficiency Cohort Study without atrial fibrillation at entry. Incident atrial fibrillation was identified by study visit ECGs, self-report, and hospital discharge diagnostic codes, with confirmation by physician adjudication. ESRD through 2012 was ascertained by participant self-report, medical records, and linkage to the US Renal Data System. Data on potential confounders were obtained from self-report, study visits, and laboratory tests. Marginal structural models were used to study the potential association of incident atrial fibrillation with risk of ESRD after adjustment for time-dependent confounding. RESULTS: Among 3091 participants, 172 (5.6%) developed incident atrial fibrillation during follow-up. During mean follow-up of 5.9 years, 43 patients had ESRD that occurred after development of incident atrial fibrillation (11.8/100 person-years) compared with 581 patients without incident atrial fibrillation (3.4/100 person-years). In marginal structural models with inverse probability weighting, incident atrial fibrillation was associated with a substantially higher rate of ESRD (hazard ratio, 3.2; 95% confidence interval, 1.9 to 5.2). This association was consistent across important subgroups by age, sex, race, diabetes status, and baseline eGFR. CONCLUSIONS: Incident atrial fibrillation was associated with higher risk of developing ESRD in CKD. Additional study is needed to identify potentially modifiable pathways through which atrial fibrillation was associated with a higher risk of progression to ESRD. More aggressive monitoring and treatment of patients with CKD and atrial fibrillation may improve outcomes in this high-risk population.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

July 7, 2016

Volume

11

Issue

7

Start / End Page

1189 / 1196

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Incidence
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Bansal, N., Xie, D., Tao, K., Chen, J., Deo, R., Horwitz, E., … CRIC Study, . (2016). Atrial Fibrillation and Risk of ESRD in Adults with CKD. Clin J Am Soc Nephrol, 11(7), 1189–1196. https://doi.org/10.2215/CJN.10921015
Bansal, Nisha, Dawei Xie, Kelvin Tao, Jing Chen, Rajat Deo, Edward Horwitz, Chi-Yuan Hsu, et al. “Atrial Fibrillation and Risk of ESRD in Adults with CKD.Clin J Am Soc Nephrol 11, no. 7 (July 7, 2016): 1189–96. https://doi.org/10.2215/CJN.10921015.
Bansal N, Xie D, Tao K, Chen J, Deo R, Horwitz E, et al. Atrial Fibrillation and Risk of ESRD in Adults with CKD. Clin J Am Soc Nephrol. 2016 Jul 7;11(7):1189–96.
Bansal, Nisha, et al. “Atrial Fibrillation and Risk of ESRD in Adults with CKD.Clin J Am Soc Nephrol, vol. 11, no. 7, July 2016, pp. 1189–96. Pubmed, doi:10.2215/CJN.10921015.
Bansal N, Xie D, Tao K, Chen J, Deo R, Horwitz E, Hsu C-Y, Kallem RK, Keane MG, Lora CM, Raj D, Soliman EZ, Strauss L, Wolf M, Go AS, CRIC Study. Atrial Fibrillation and Risk of ESRD in Adults with CKD. Clin J Am Soc Nephrol. 2016 Jul 7;11(7):1189–1196.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

July 7, 2016

Volume

11

Issue

7

Start / End Page

1189 / 1196

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Incidence
  • Humans