Gan Yangang, Nie Sheng, Pang Mingzhen, Huang Rong, Xu Hong, Liu Bicheng, Weng Jianping, Chunbo Chen, Liu Huafeng, Li Hua, Kong Yaozhong, Li Guisen, Wan Qijun, Zha Yan, Hu Ying, Xu Gang, Shi Yongjun, Zhou Yilun, Su Guobin, Tang Ying, Gong Mengchun, Hou Fan Fan, Yang Qiongqiong
Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
Clin Kidney J. 2024 May 13;17(8):sfae137. doi: 10.1093/ckj/sfae137. eCollection 2024 Aug.
Electrolyte abnormalities are common symptoms of chronic kidney disease (CKD), but previous studies have mainly focussed on serum potassium and sodium levels. Chloride is an important biomarker for the prognosis of various diseases. However, the relationship between serum chloride levels and atrial fibrillation (AF) in CKD patients is unclear.
In this study, we sought to determine the association between serum chloride homeostasis and AF in CKD patients.
In this retrospective cohort study, we included patients who met the diagnostic criteria for CKD in China between 2000 and 2021. Competing risk regression for AF was performed. The associations of the baseline serum chloride concentration with heart failure (HF) and stroke incidence were also calculated by competing risk regression. The association of baseline serum chloride levels with all-cause death was determined by a Cox regression model.
The study cohort comprised 20 550 participants. During a median follow-up of 350 days (interquartile range, 123-730 days), 211 of the 20 550 CKD patients developed AF. After multivariable adjustment, every decrease in the standard deviation of serum chloride (5.02 mmol/l) was associated with a high risk for AF [sub-hazard ratio (sHR) 0.78, 95% confidence interval (CI) 0.65-0.94, = .008]. These results were also consistent with those of the stratified and sensitivity analyses. According to the fully adjusted models, the serum chloride concentration was also associated with a high risk for incident HF (sHR 0.85, 95% CI 0.80-0.91, < .001), a high risk for incident stroke (sHR 0.87, 95% CI 0.81-0.94, < .001), and a high risk for all-cause death [hazard ratio (HR) 0.82, 95% CI 0.73-0.91, < .001].
In this CKD population, serum chloride levels were independently and inversely associated with the incidence of AF. Lower serum chloride levels were also associated with an increased risk of incident HF, stroke, and all-cause death.
电解质异常是慢性肾脏病（CKD）的常见症状，但既往研究主要关注血清钾和钠水平。氯离子是多种疾病预后的重要生物标志物。然而，CKD患者血清氯离子水平与心房颤动（AF）之间的关系尚不清楚。
在本研究中，我们试图确定CKD患者血清氯离子稳态与AF之间的关联。
在这项回顾性队列研究中，我们纳入了2000年至2021年间符合中国CKD诊断标准的患者。对AF进行竞争风险回归分析。还通过竞争风险回归分析计算基线血清氯离子浓度与心力衰竭（HF）和卒中发生率的关联。通过Cox回归模型确定基线血清氯离子水平与全因死亡的关联。
研究队列包括20550名参与者。在中位随访350天（四分位间距，123 - 730天）期间，20550名CKD患者中有211人发生AF。多变量调整后，血清氯离子标准差每降低5.02 mmol/L与AF高风险相关[亚风险比（sHR）0.78，95%置信区间（CI）0.65 - 0.94，P = 0.008]。这些结果在分层分析和敏感性分析中也一致。根据完全调整模型，血清氯离子浓度还与HF发生风险高（sHR 0.85，95% CI 0.80 - 0.91，P < 0.001）、卒中发生风险高（sHR 0.87，95% CI 0.81 - 0.94，P < 0.001）以及全因死亡风险高[风险比（HR）0.82，95% CI 0.73 - 0.91，P < 0.001]相关。
在这个CKD人群中，血清氯离子水平与AF发生率独立且呈负相关。较低的血清氯离子水平还与HF、卒中和全因死亡发生风险增加相关。
