Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
J Am Heart Assoc. 2017 Jul 6;6(7):e005685. doi: 10.1161/JAHA.117.005685.
Early evidence suggests proteinuria is independently associated with incident atrial fibrillation (AF). We sought to investigate whether the association of proteinuria with incident AF is altered by kidney function.
Retrospective cohort study using administrative healthcare databases in Ontario, Canada (2002-2015). A total of 736 666 patients aged ≥40 years not receiving dialysis and with no previous history of AF were included. Proteinuria was defined using the urine albumin-to-creatinine ratio (ACR) and kidney function by the estimated glomerular filtration rate (eGFR). The primary outcome was time to AF. Cox proportional models were used to determine the hazard ratio for AF censored for death, dialysis, kidney transplant, or end of follow-up. Fine and Grey models were used to determine the subdistribution hazard ratio for AF, with death as a competing event. Median follow-up was 6 years and 44 809 patients developed AF. In adjusted models, ACR and eGFR were associated with AF (<0.0001). The association of proteinuria with AF differed based on kidney function (ACR × eGFR interaction, <0.0001). Overt proteinuria (ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact (eGFR, 120) versus reduced (eGFR, 30) kidney function (adjusted hazard ratios, 4.5 [95% CI, 4.0-5.1] and 2.6 [95% CI, 2.4-2.8], respectively; referent ACR 0 and eGFR 120). Results were similar in competing risk analyses.
Proteinuria increases the risk of incident AF markedly in patients with intact kidney function compared with those with decreased kidney function. Screening and preventative strategies should consider proteinuria as an independent risk factor for AF.
早期证据表明蛋白尿与房颤（AF）的发生独立相关。我们试图研究蛋白尿与房颤发生的相关性是否因肾功能而改变。
这是一项使用加拿大安大略省的医疗保健管理数据库进行的回顾性队列研究（2002-2015 年）。共纳入 736666 名年龄≥40 岁且未接受透析且无房颤既往史的患者。蛋白尿使用尿白蛋白/肌酐比值（ACR）定义，肾功能使用估算肾小球滤过率（eGFR）定义。主要结局为房颤发生时间。Cox 比例风险模型用于确定房颤的风险比，该模型在死亡、透析、肾移植或随访结束时进行了校正。Fine 和 Grey 模型用于确定房颤的亚分布风险比，死亡作为竞争事件。中位随访时间为 6 年，44809 例患者发生房颤。在调整后的模型中，ACR 和 eGFR 与房颤相关（<0.0001）。蛋白尿与房颤的相关性取决于肾功能（ACR×eGFR 交互作用，<0.0001）。在肾功能正常（eGFR，120）的患者中，显性蛋白尿（ACR，120mg/mmol）与房颤风险增加相关，而在肾功能降低（eGFR，30）的患者中，这种相关性较弱（调整后的风险比分别为 4.5[95%CI，4.0-5.1]和 2.6[95%CI，2.4-2.8]；参考 ACR 0 和 eGFR 120）。竞争风险分析的结果相似。
与肾功能降低的患者相比，肾功能正常的患者蛋白尿显著增加房颤发生的风险。筛查和预防策略应将蛋白尿视为房颤的独立危险因素。
