Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27104, USA.
Am Heart J. 2010 Jun;159(6):1102-7. doi: 10.1016/j.ahj.2010.03.027.
The epidemiology of atrial fibrillation (AF) has been mainly investigated in patients with end-stage renal disease, with limited data on less advanced chronic kidney disease (CKD) stages.
A total of 3,267 adult participants (50% non-Hispanic blacks, 46% women) with CKD from the Chronic Renal Insufficiency Cohort were included in this study. None of the study participants had been on dialysis. Those with self-identified race/ethnicity other than non-Hispanic black or white (n = 323) or those without electrocardiographic data (n = 22) were excluded. Atrial fibrillation was ascertained by a 12-lead electrocardiogram and self-report. Age-, sex-, and race/ethnicity-specific prevalence rates of AF were estimated and compared between subgroups. Cross-sectional associations and correlates with prevalent AF were examined using unadjusted and multivariable-adjusted logistic regression analysis.
The mean estimated glomerular filtration rate was 43.6 (+/-13.0) mL/(min 1.73 m(2)). Atrial fibrillation was present in 18% of the study population and in >25% of those > or =70 years old. In multivariable-adjusted models, 1-SD increase in age (11 years) (odds ratio 1.27, CI 95% 1.13-1.43, P < .0001), male [corrected] sex (0.80, 0.65-0.98, P = .0303), smoking (former vs never) (1.34, 1.08-1.66, P = .0081), history of heart failure (3.28, 2.47-4.36, P < .001), and history of cardiovascular disease (1.94, 1.56-2.43, P < .0001) were significantly associated with AF. Race/ethnicity, hypertension, diabetes, body mass index, physical activity, education, high-sensitivity C-reactive protein, total cholesterol, and alcohol intake were not significantly associated with AF. An estimated glomerular filtration rate <45 mL/(min 1.73 m(2)) was associated with AF in an unadjusted model (1.35, 1.13-1.62, P = .0010), but not after multivariable adjustment (1.12, 0.92-1.35, P = .2710).
Nearly 1 in 5 participants in Chronic Renal Insufficiency Cohort, a national study of CKD, had evidence of AF at study entry, a prevalence similar to that reported among patients with end-stage renal disease and 2 to 3 times of that reported in the general population. Risk factors for AF in this CKD population do not mirror those reported in the general population.
心房颤动（AF）的流行病学主要在终末期肾病患者中进行了研究，关于慢性肾脏病（CKD）早期阶段的数据有限。
本研究共纳入了来自慢性肾功能不全队列的 3267 名成年参与者（50%为非西班牙裔黑人，46%为女性）。研究中没有参与者接受过透析治疗。那些自我认定的种族/民族不属于非西班牙裔黑人或白人（n=323）或没有心电图数据（n=22）的人被排除在外。心房颤动通过 12 导联心电图和自我报告来确定。根据年龄、性别和种族/民族特异性，估计并比较了 AF 的患病率。使用未调整和多变量调整的逻辑回归分析，研究了与常见 AF 相关的横断面关联和相关因素。
研究人群的平均估计肾小球滤过率为 43.6（+/-13.0）mL/（min 1.73 m(2)）。研究人群中有 18%存在心房颤动，>70 岁的患者中>25%存在心房颤动。在多变量调整模型中，年龄（11 岁）每增加 1-SD（比值比 1.27，95%置信区间 1.13-1.43，P<.0001）、男性[纠正]性别（0.80，0.65-0.98，P=0.0303）、吸烟（以前吸烟与从不吸烟）（1.34，1.08-1.66，P=0.0081）、心力衰竭史（3.28，2.47-4.36，P<.001）和心血管疾病史（1.94，1.56-2.43，P<.0001）与 AF 显著相关。种族/民族、高血压、糖尿病、体重指数、体力活动、教育、高敏 C 反应蛋白、总胆固醇和饮酒量与 AF 无显著相关性。肾小球滤过率估计值<45 mL/（min 1.73 m(2)）与未调整模型中的 AF 相关（1.35，1.13-1.62，P=0.0010），但在多变量调整后无相关性（1.12，0.92-1.35，P=0.2710）。
在慢性肾功能不全队列（一项针对 CKD 的全国性研究）中，近 1/5 的参与者在研究入组时存在 AF 证据，其患病率与终末期肾病患者相似，是普通人群的 2 至 3 倍。该 CKD 人群中 AF 的危险因素与普通人群中的危险因素并不相同。
