Watanabe Hiroshi, Watanabe Toru, Sasaki Shigeru, Nagai Kojiro, Roden Dan M, Aizawa Yoshifusa
Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Am Heart J. 2009 Oct;158(4):629-36. doi: 10.1016/j.ahj.2009.06.031.
Atrial fibrillation (AF) and chronic kidney disease share risk factors and pathophysiologic mechanisms, suggesting that two conditions have close relationships.
This is a prospective community-based observational cohort study including 235,818 subjects based upon a voluntary annual health check-up program in Japan. We studied the association of kidney dysfunction at entry with subsequent new-onset AF and the association of AF at entry with the development of kidney disease.
During a follow-up of 5.9 +/- 2.4 years, AF developed in 2947 subjects (1.3%). Baseline serum creatinine and estimated glomerular filtration rate (GFR) were associated with risk of subsequent AF. The HRs (95% CI) for AF were 1.32 (1.08-1.62) and 1.57 (0.89-2.77) for GFR 30 to 59 and <30 mL/min per 1.73 m(2), respectively. The effect of kidney disease on risk of new-onset AF remained significant in subjects without treated hypertension or diabetes. During the follow-up, 7791 subjects (3.3%) developed kidney dysfunction (GFR <60 mL/min per 1.73 m(2)), and 11 307 subjects (4.9%) developed proteinuria. Atrial fibrillation at entry was associated with development of kidney dysfunction (HRs [95% CI], 1.77 [1.50-2.10]) and proteinuria (HR [95% CI], 2.20 [1.92-2.52]). The association persisted in subjects without treated hypertension or diabetes.
Kidney dysfunction increased the risk of new onset of AF, and AF increased the risk of development of kidney disease. This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis.
心房颤动（AF）与慢性肾脏病有共同的危险因素和病理生理机制，提示二者关系密切。
这是一项基于社区的前瞻性观察队列研究，纳入了日本一项自愿年度健康检查项目中的235818名受试者。我们研究了入组时肾功能不全与随后新发房颤的关联，以及入组时房颤与肾脏病发生的关联。
在5.9±2.4年的随访期间，2947名受试者（1.3%）发生了房颤。基线血清肌酐和估计肾小球滤过率（GFR）与随后发生房颤的风险相关。GFR为30至59以及<30 mL/min per 1.73 m²时，房颤的HR（95%CI）分别为1.32（1.08 - 1.62）和1.57（0.89 - 2.77）。在未接受高血压或糖尿病治疗的受试者中，肾脏病对新发房颤风险的影响仍然显著。随访期间，7791名受试者（3.3%）出现肾功能不全（GFR<60 mL/min per 1.73 m²），11307名受试者（4.9%）出现蛋白尿。入组时的房颤与肾功能不全（HR[95%CI]，1.77[1.50 - 2.10]）和蛋白尿（HR[95%CI]，2.20[1.92 - 2.52]）的发生相关。这种关联在未接受高血压或糖尿病治疗的受试者中持续存在。
肾功能不全会增加新发房颤的风险，而房颤会增加肾脏病发生的风险。这一发现支持了两种疾病共享共同的异常分子信号通路参与其发病机制的概念。
