Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Minneapolis, MN 55454, USA.
Circulation. 2011 Jun 28;123(25):2946-53. doi: 10.1161/CIRCULATIONAHA.111.020982. Epub 2011 Jun 6.
Chronic kidney disease is associated with the incidence of cardiovascular disease. Chronic kidney disease may also increase the risk of atrial fibrillation (AF), but existing studies have reported inconsistent results.
We estimated cystatin C-based glomerular filtration rate (eGFR(cys)) and measured urinary albumin-to-creatinine ratio (ACR) in 10 328 men and women free of AF from the Atherosclerosis Risk in Communities (ARIC) Study in 1996 to 1998. Incidence of AF was ascertained through the end of 2007. During a median follow-up of 10.1 years, we identified 788 incident AF cases. Compared with individuals with eGFR(cys) ≥90 mL · min(-1) · 1.73 m(-2), multivariable hazard ratios and 95% confidence intervals (CIs) of AF were 1.3 (95% CI, 1.1 to 1.6), 1.6 (95% CI, 1.3 to 2.1), and 3.2 (95% CI, 2.0 to 5.0; P for trend <0.0001) in those with eGFR(cys) of 60 to 89, 30 to 59, and 15 to 29 mL · min(-1) · 1.73 m(-2), respectively. Similarly, the presence of macroalbuminuria (ACR ≥300 mg/g; hazard ratio, 3.2; 95% CI, 2.3 to 4.5) and microalbuminuria (ACR, 30 to 299 mg/g; hazard ratio, 2.0; 95% CI, 1.6 to 2.4) was associated with higher AF risk compared with those with ACR <30 mg/g. Risk of AF was particularly elevated in those with both low eGFR(cys) and macroalbuminuria (hazard ratio, 13.1; 95% CI, 6.0 to 28.6, comparing individuals with ACR ≥300 mg/g and eGFR(cys) of 15 to 29 mL · min(-1) · 1.73 m(-2) and those with ACR <30 mg/g and eGFR(cys) ≥90 mL · min(-1) · 1.73 m(-2)).
In this large population-based study, reduced kidney function and presence of albuminuria were strongly associated with the incidence of AF independently of other risk factors.
慢性肾脏病与心血管疾病的发生有关。慢性肾脏病也可能增加心房颤动（AF）的风险，但现有研究的结果并不一致。
我们在 1996 年至 1998 年的社区动脉粥样硬化风险研究（ARIC）中，对 10328 名无 AF 的男性和女性进行了基于半胱氨酸蛋白酶抑制剂的肾小球滤过率（eGFR（cys））估计和尿白蛋白与肌酐比值（ACR）测量。通过 2007 年底确定 AF 的发病情况。在中位随访 10.1 年后，我们发现了 788 例新发 AF 病例。与 eGFR（cys）≥90 mL·min（-1）·1.73 m（-2）的个体相比，eGFR（cys）为 60 至 89、30 至 59 和 15 至 29 mL·min（-1）·1.73 m（-2）的个体发生 AF 的多变量风险比和 95%置信区间（95%CI）分别为 1.3（95%CI，1.1 至 1.6）、1.6（95%CI，1.3 至 2.1）和 3.2（95%CI，2.0 至 5.0；P<0.0001）。同样，存在大量白蛋白尿（ACR≥300 mg/g；风险比，3.2；95%CI，2.3 至 4.5）和微量白蛋白尿（ACR，30 至 299 mg/g；风险比，2.0；95%CI，1.6 至 2.4）与 AF 风险增加相关与 ACR<30 mg/g 的个体相比。与 eGFR（cys）≥90 mL·min（-1）·1.73 m（-2）和 ACR≥300 mg/g 的个体相比，eGFR（cys）为 15 至 29 mL·min（-1）·1.73 m（-2）和 ACR<30 mg/g 的个体发生 AF 的风险尤其高（风险比，13.1；95%CI，6.0 至 28.6）。
在这项大型基于人群的研究中，肾功能降低和白蛋白尿的存在与 AF 的发生独立于其他危险因素密切相关。
