Key result
Atrial fibrillation was independently associated with an 86% increased risk of all-cause mortality (HR 1.86) and significantly higher risks of ischemic and hemorrhagic stroke in adults with CKD.
Why the study?
Atrial fibrillation is associated with adverse outcomes in the general population, but its impact on patients with chronic kidney disease remains unclear.
Does atrial fibrillation increase the risk of mortality and stroke in adults with chronic kidney disease?
Cohort (n=21,587)
Yes
Does atrial fibrillation increase the risk of mortality and stroke in adults with chronic kidney disease?
Hazard Ratio: 1.86 (95% CI 1.33–2.59)
p-value: p=<0.001
In adults with chronic kidney disease, the presence of atrial fibrillation is independently associated with significantly increased risks of all-cause mortality, ischemic stroke, and hemorrhagic stroke.
AF identifies high-risk CKD patients for closer monitoring; extends observational data but leaves optimal management open pending trials.
OBJECTIVE: Atrial fibrillation (AF) is associated with adverse outcomes in the general population, but its impact on patients with chronic kidney disease (CKD) remains unclear. In this study, we assessed the association between AF and risks of all-cause mortality and stroke in Chinese adults with CKD. METHODS: We enrolled adults aged 45 years or older with CKD (defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2 and/or proteinuria identified using the urine dipstick method) from the Kailuan study between 2008 and 2014. AF was identified by 12-lead electrocardiography or hospital discharge diagnostic codes. Mortality data were collected from the provincial vital statistics, and physician-diagnosed ischemic or hemorrhagic stroke was confirmed in the biennial interview. RESULTS: Among the 21587 CKD adults, 216 patients were identified with AF, the median follow-up duration was 5.21 years (5.69 ± 1.96 years); During follow-up, there were 70 cases of death, and 16 cases of ischemic stroke and 6 cases of hemorrhagic stroke in the participants with AF in comparison with 2572 cases of death and 656 cases of ischemic stroke and 184 cases of hemorrhagic stroke among the participants without AF. After adjustment for potential confounders, AF was associated with an 86% increase in the rate of death (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.33-2.59, P<0.001), a 104% (HR, 2.04; 95% CI, 1.09-3.83, P = 0.026) and 325% (HR, 4.25; 95% CI, 1.74-10.36, P = 0.001) increase in the rate of ischemic stroke and hemorrhagic stroke, respectively. These associations were still consistent and strong after propensity score-matched analysis. CONCLUSION: Our study shows that AF is independently associated with increased risk of all-cause mortality, ischemic and hemorrhagic stroke in Chinese CKD adults. Future studies are required to elucidate the physiological mechanisms underlying this association.
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Zhang et al. (2020) conducted a cohort in Chronic kidney disease (n=21,587). Atrial fibrillation vs. No atrial fibrillation was evaluated on All-cause mortality (HR 1.86, 95% CI 1.33-2.59, p=<0.001). Atrial fibrillation was independently associated with an 86% increased risk of all-cause mortality (HR 1.86) and significantly higher risks of ischemic and hemorrhagic stroke in adults with CKD.
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