Department of Medicine, University of Ottawa, Ottawa, Canada.
Institute for Clinical Evaluative Sciences, Ontario, Canada.
Am J Kidney Dis. 2018 Feb;71(2):191-199. doi: 10.1053/j.ajkd.2017.08.016. Epub 2017 Nov 16.
The association of atrial fibrillation (AF), estimated glomerular filtration rate (eGFR), and adverse events remains unknown.
Population-based retrospective cohort study from Ontario, Canada.
SETTING & PARTICIPANTS: 1,422,978 adult residents with eGFRs < 90mL/min/1.73m from April 1, 2006, through March 31, 2015.
A diagnosis of AF at hospitalization.
Congestive heart failure (CHF), myocardial infarction (MI), end-stage kidney disease, all-cause mortality.
All adverse events were more frequent in individuals with AF (93,414 propensity score matched) compared to no AF, and this difference was more pronounced within the first 6 months of the index date (CHF: 3.04% [AF] vs 0.28% [no AF], subdistribution HR [sHR] of 11.57 [95% CI, 10.26-13.05]; MI: 0.97% [AF] vs 0.21% [no AF], sHR of 4.76 [95% CI, 4.17-5.43]; end-stage kidney disease: 0.16% [AF] vs 0.03% [no AF], sHR of 5.84 [95% CI, 3.82-8.93]; and all-cause mortality: 6.11% [AF] vs 2.50% [no AF], HR of 2.62 [95% CI, 2.50-2.76]) than in the period more than 6 months after the index date (CHF: 6.87% [AF] vs 2.87% [no AF], sHR of 2.64 [95% CI, 2.55-2.74]; MI: 2.21% [AF] vs 1.81% [no AF], sHR of 1.24 [95% CI, 1.18-1.30]; end-stage kidney disease: 0.52% [AF] vs 0.32% [no AF], sHR of 1.75 [95% CI, 1.57-1.95]; and all-cause mortality: 15.55% [AF] vs 15.10% [no AF], HR of 1.07 [95% CI, 1.04-1.10]). The results accounted for the competing risk for mortality. eGFR level modified the effect of AF on CHF (P for interaction < 0.05).
Observational study design does not permit determination of causality; only a single outpatient eGFR measure was used; medication data were not included.
Incident AF is associated with a high risk for adverse outcomes in patients with eGFRs < 90mL/min/1.73m. Because the risk is exceedingly high within the first 6 months after AF diagnosis, therapeutic interventions and monitoring may improve outcomes.
心房颤动（AF）、估计肾小球滤过率（eGFR）和不良事件之间的关联尚不清楚。
这是一项来自加拿大安大略省的基于人群的回顾性队列研究。
2006 年 4 月 1 日至 2015 年 3 月 31 日，共有 1422978 名 eGFR<90mL/min/1.73m 的成年居民。
住院时诊断为 AF。
与无 AF 相比，所有不良事件在有 AF 的个体中更为常见（93414 例倾向评分匹配），并且这种差异在索引日期后的前 6 个月更为明显（心力衰竭：3.04%[AF] vs 0.28%[无 AF]，亚分布风险比[sHR]为 11.57[95%CI，10.26-13.05]；心肌梗死：0.97%[AF] vs 0.21%[无 AF]，sHR 为 4.76[95%CI，4.17-5.43]；终末期肾病：0.16%[AF] vs 0.03%[无 AF]，sHR 为 5.84[95%CI，3.82-8.93]；全因死亡率：6.11%[AF] vs 2.50%[无 AF]，HR 为 2.62[95%CI，2.50-2.76]），而在索引日期后超过 6 个月的时期则更为明显（心力衰竭：6.87%[AF] vs 2.87%[无 AF]，sHR 为 2.64[95%CI，2.55-2.74]；心肌梗死：2.21%[AF] vs 1.81%[无 AF]，sHR 为 1.24[95%CI，1.18-1.30]；终末期肾病：0.52%[AF] vs 0.32%[无 AF]，sHR 为 1.75[95%CI，1.57-1.95]；全因死亡率：15.55%[AF] vs 15.10%[无 AF]，HR 为 1.07[95%CI，1.04-1.10]）。结果考虑了死亡率的竞争风险。eGFR 水平改变了 AF 对心力衰竭的影响（交互作用 P<0.05）。
观察性研究设计不能确定因果关系；仅使用了单次门诊 eGFR 测量值；未包括药物数据。
新发 AF 与 eGFR<90mL/min/1.73m 患者不良结局的风险增加有关。由于在 AF 诊断后的前 6 个月内风险极高，因此治疗干预和监测可能会改善结局。
