Study on the risk of atrial fibrillation for new-onset chronic kidney disease in northern China

Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-01-28 Cooperative journals: 《中国全科医学》

Aili ZHANG Qiqi HOU Quanle HAN Boheng ZHANG Jiawei ZHANG Hongxia CAO Chao ZHANG Shuohua CHEN Shouling WU Kangbo LI

Abstract：

Background　 The global population disease burden report shows that atrial fibrillation and chronic kidney disease (CKD) have become one of the fastest growing causes of death in the past 20 years. The concept of cardiorenal syndrome points out that atrial fibrillation may increase the risk of new-onset chronic kidney disease， but at present， there are few relevant studies on atrial fibrillation increasing the risk of new-onset chronic kidney disease at home and abroad， and the interaction between atrial fibrillation and age is not clear．Objective　To investigate whether atrial fibrillation (AF) increases the risk of new-onset chronic kidney disease (CKD) in northern China. Methods　Prospective cohort study was used to select the population (Kailuan population) (n=135168， age 18-98 years old) who participated in the health examination for employees of Kailuan Group in Hebei Province from June 2006 to October 2010， excluding 19883 people with missing data and CKD history， 4430 people with previous cerebrovascular and cardiovascular diseases， malignant tumors， AF during follow-up， and 110855 people finally， The patients were divided into AF group and non AF group according to whether they had AF or not， including 368 patients with AF and 110487 patients with non AF. The follow-up was conducted once a year. The final follow-up date was December 31， 2020， with a median follow-up of 13.46 (9.70，14.05) years. The end point was new-onset CKD. Statistically analyze whether AF affects the risk of new-onset CKD. Results　(1) 368 patients (63.43±10.61) years old， 338 males (91.85%) in AF group; 110487 persons in non AF group， age (49.04±12.92)， male 88288 (79.91%); Comparison of age (years)， sex (male)， diastolic blood pressure (DBP)， systolic blood pressure (SBP)， body mass index (BMI)， total cholesterol (TC)， low-density lipoprotein cholesterol (LDL-C)， triglyceride (TG)，high-sensitivity C-reactive protein (Hs CRP)， education level (high school or above)， drinking， participating in physical exercise， hypertension， diabetes， taking antihypertensive drugs， taking hypoglycemic drugs between the atrial fibrillation group and the non atrial fibrillation group， The differences were statistically significant (P<0.01 or P<0.05); There was no significant difference in fasting blood glucose (FPG)， high-density lipoprotein cholesterol (HDL-C)， smoking， and taking lipid-lowering drugs between the AF group and the non AF group (P>0.05); (2) 95 new-onset cases of CKD in AF group， with a cumulative incidence rate of 30.40%; 110487 people in the non atrial fibrillation group， 22725 people with new-onset CKD， the cumulative incidence rate was 21.77%， and the cumulative incidence rate of the two groups was statistically significant (x2=14.30， P<0.001); The incidence density of AF group and non AF group was 28.63‰ person year and 18.48‰ person year respectively; (3) Compared with non AF group， AF group increased the risk of new CKD [HR=1.477，95% CI (1.208，1.806， P<0.001)]; Age stratification was performed. For people≤65 years old， AF increased the risk of new-onset CKD [HR=1.566，95% CI (1.024，2.035)， P=0.001]; For people over 65 years old， AF no longer increases the risk of CKD [HR=0.970，95% CI (0.707，1.330)， P=0.855]; After further adjustment of age， sex (male) by multivariate Cox proportional hazard regression analysis， AF no longer increased the risk of CKD in the whole population and the population over 65 years old [HR=1.167，95% CI (0.954，1.428)， P=0.133]， [HR=1.007，95% CI (0.734，1.381)， P=0.968]; For people≤65 years old， AF still increased the risk of CKD [HR=1.363，95% CI (1.048，1.769)， P=0.021]; After further adjusting for smoking， drinking， participating in physical exercise， high school and above education background， hypertension history， diabetes history， taking antihypertensive drugs， taking hypoglycemic drugs， taking lipid-lowering drugs， BMI， TG， HDL-C， LDL-C， FPG， Hs-CRP by multivariate Cox proportional hazard regression analysis， only people aged≤65 years old had AF increased the risk of CKD [HR=1.351，95% CI (1.038，1.755)， P=0.025].Conclusion　AF is an independent risk factor for new-onset CKD in northern China， especially for young and middle-aged people≤65 years old.

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