Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, Stockholm, 17177, Sweden.
Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden.
BMC Cardiovasc Disord. 2024 Oct 22;24(1):581. doi: 10.1186/s12872-024-04236-9.
Uric acid closely relates to both kidney disease and atrial fibrillation (AF), yet the extent to which it influences the kidney-AF association remains uncertain. We examined the relationship between kidney function and risk of AF, accounting for uric acid levels.
A total of 308,509 individuals in the Swedish Apolipoprotein-Related Mortality Risk (AMORIS) cohort were included and their serum creatinine and uric acid were measured during 1985-1996. Ten-year incident AF was identified via linkage with the national registers. Glomerular filtration rate (eGFR) (ml/min/1.73 m) was calculated with the 2009 Chronic Kidney Disease Epidemiology Collaboration equation. Hyperuricemia was defined as > 420 µmol/L for men and > 360 µmol/L for women.
Over a mean follow-up of 9.4 years, 10,007 (3.2%) incident AF cases occurred. After adjusting for age, sex, cardiovascular diseases, total cholesterol, triglycerides, and glucose, individuals with low eGFR (< 30 and 30-59 ml/min/1.73 m ) had a higher risk of AF compared to those with normal eGFR (60-89) (hazard ratio (HR) = 1.72, 95% confidence interval (CI):1.29-2.30; HR = 1.10, 95% CI: 1.03-1.18, respectively). After further adjusting for uric acid levels, the association disappeared (HR = 0.97, 95% CI: 0.72-1.30; HR = 0.93, 95% CI: 0.86-1.00, respectively). When stratifying by hyperuricemia yes/no, eGFR < 30 ml/min/1.73 m was associated with higher AF risk in a small group of individuals without hyperuricemia (HR = 2.58, 95% CI: 1.64-4.07).
Uric acid largely accounted for the relationship between eGFR and AF in this study. However, in individuals without hyperuricemia, eGFR in the lowest range (< 30 ml/min/1.73 m) was still associated with increased risk of AF.
尿酸与肾脏疾病和心房颤动（AF）密切相关，但尿酸对肾脏-房颤关联的影响程度仍不确定。我们研究了肾功能与 AF 风险之间的关系，同时考虑了尿酸水平。
共纳入瑞典载脂蛋白相关死亡率风险（AMORIS）队列中的 308509 人，于 1985 年至 1996 年期间测量其血清肌酐和尿酸。通过与国家登记处的链接确定 10 年的房颤事件。肾小球滤过率（eGFR）（ml/min/1.73 m）用 2009 年慢性肾脏病流行病学合作研究方程计算。高尿酸血症定义为男性> 420 µmol/L，女性> 360 µmol/L。
平均随访 9.4 年后，共发生 10007 例（3.2%）房颤事件。在调整年龄、性别、心血管疾病、总胆固醇、甘油三酯和葡萄糖后，与 eGFR 正常（60-89）相比，eGFR 较低（< 30 和 30-59 ml/min/1.73 m）的个体发生房颤的风险更高（风险比（HR）= 1.72，95%置信区间（CI）：1.29-2.30；HR = 1.10，95% CI：1.03-1.18）。进一步调整尿酸水平后，这种关联消失（HR = 0.97，95% CI：0.72-1.30；HR = 0.93，95% CI：0.86-1.00）。按高尿酸血症阳性/阴性分层时，在尿酸正常的小部分个体中，eGFR < 30 ml/min/1.73 m 与房颤风险升高相关（HR = 2.58，95% CI：1.64-4.07）。
在这项研究中，尿酸在很大程度上解释了 eGFR 与 AF 之间的关系。然而，在没有高尿酸血症的个体中，最低 eGFR 范围（< 30 ml/min/1.73 m）仍与 AF 风险增加相关。
