Atrial fibrillation and incident end-stage renal disease: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

IntroductionAtrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD), however, the association between AF and incident ESRD has not been examined in the general United States population.MethodsA total of 24,953 participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified at baseline (2003–2007) from electrocardiogram data and self-reported history. Incident cases of ESRD were identified through linkage with the United States Renal Data System. Cox proportional-hazards regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between AF and incident ESRD.ResultsA total of 2,155 (8.6%) participants had AF at baseline. Over a median follow-up of 7.4 years, 295 (1.2%) persons developed ESRD. In a model adjusted for demographics and potential confounders, AF was associated with an increased risk of incident ESRD (HR = 1.51, 95% CI = 1.08, 2.11). The association between AF and ESRD became non-significant after further adjustment for CKD markers (eGFR < 60 mL/min/1.73 m2 and urine albumin-to-creatinine ratio ≥ 30 mg/dL) (HR = 1.24, 95% CI = 0.89, 1.73).ConclusionAF is associated with an increased risk of ESRD in the general United States population and this association potentially is explained by underlying CKD.