What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes mellitus and proteinuria (n=240499). Intervention: Diabetes mellitus with proteinuria vs. Participants without diabetes mellitus and proteinuria. Primary outcome: Incident atrial fibrillation (HR 1.66, 95% CI 1.26-2.18, p=<0.001).

August 23, 2021Scientific Reports9 citationsOpen Access

Association of proteinuria and incident atrial fibrillation in patients with diabetes mellitus: a population-based senior cohort study

Q: What are the key findings of this study?

In an elderly population, the presence of both diabetes mellitus and proteinuria increased the risk of incident atrial fibrillation by 66% compared to controls without either condition (HR 1.66).

JKJuntae KimYonsei University PYPil‐Sung YangYonsei University BPByoung‐Eun ParkDankook University

Key Result

In an elderly population, the presence of both diabetes mellitus and proteinuria increased the risk of incident atrial fibrillation by 66% compared to controls without either condition (HR 1.66).

Study Design

Type

Cohort (n=240,499)

Structured PICO

Does the presence of proteinuria increase the risk of incident atrial fibrillation in elderly patients with diabetes mellitus?

Population

240,499 individuals aged 60 years and older from a nationwide Korean cohort, free of prior atrial fibrillation, followed for a median of 7.1 years to assess the risk of incident atrial fibrillation associated with diabetes and proteinuria.

Exposure

Diabetes mellitus with or without proteinuria (assessed by urine dipstick test ≥ 1+)

Comparator

Controls (participants without proteinuria and without diabetes mellitus)

Outcome

Incident atrial fibrillationhard clinical

Proteinuria assessed by a simple urine dipstick test is associated with a significantly higher, dose-dependent risk of incident atrial fibrillation in elderly patients with diabetes mellitus.

Main Result

Hazard Ratio: 1.66 (95% CI 1.26–2.18)

Absolute Event Rate: 1% vs 0.6%

p-value: p=<0.001

Limitations

Susceptible to errors arising from coding inaccuracies in administrative databases.
Urine dipstick test only reflects proteinuria in spot urine and has low diagnostic accuracy.
Could not exclude transient benign proteinuria or designate a specific cause of proteinuria.
Residual unidentified confounders may remain due to the observational nature of the study.

Abstract

Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02-1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30-1.69, P < .001), and 66% (hazard ratio = 1.66, 95% confidence interval = 1.26-2.18, P < .001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend < .001). Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Thus, assessing proteinuria by a simple urine dipstick test could provide a useful adjunct to risk assessment for AF in elderly population with DM.

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