TY - JOUR
T1 - Relation of renal dysfunction with incident atrial fibrillation and cardiovascular morbidity and mortality
T2 - The PREVEND study
AU - Marcos, Ernaldo G
AU - Geelhoed, Bastiaan
AU - Van Der Harst, Pim
AU - Bakker, Stefan J L
AU - Gansevoort, Ron T
AU - Hillege, Hans L
AU - Van Gelder, Isabelle C
AU - Rienstra, Michiel
N1 - Funding Information:
The PREVEND study was supported by the Dutch Kidney Foundation (Grant E0.13) and the Netherlands Heart Foundation (Grant NHS2010B280). Dr. Rienstra is supported by a grant from the Netherlands Organization for Scientific Research (Veni Grant 016.136.055).
Publisher Copyright:
© The Author 2017.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Aims: Renal dysfunction is a risk factor for cardiovascular disease, including atrial fibrillation (AF) and mortality. However, the exact pathobiology linking different renal dysfunction measures, such as albumin excretion or glomerular filtration rate (GFR), to cardiovascular- and AF risk are unclear. In this study, we investigated the association of several renal function measures and incident AF, and whether the relation between renal measures and outcomes is modified by AF.Methods and results: We examined 8265 individuals (age 49 ± 13 years, 50% women) included in the PREVEND study. We used albumin excretion (morning void and 24-h urine samples), serum creatinine, cystatin C, and Cystatin C-based, creatinine-based, and creatinine-cystatin C-based GFR as renal function measures; results: During a follow-up of 9.8 ± 2.3 years, 267 participants (3.2%) developed AF. In the multivariate-adjusted model, GFR, estimated by creatinine, cystatin C, or the combination was not associated with incident AF. However, increased albumin excretion was strongly associated with incident AF; urine albumin concentration and excretion (HRmorning void 1.10, P = 0.005 and HR24-hr collection 1.05, P = 0.033) and albumin creatinine ratio (HRmorning void 1.05, P = 0.010 and HR24-hr collection 1.06, P < 0.001). Interaction terms of incident AF and renal measures were not significant for incident cerebrovascular events, peripheral vascular events, ischemic heart disease, heart failure, and mortality.Conclusion: In this community-based cohort, increased albumin excretion, and not GFR, was associated with incident AF, independent of established cardiovascular risk factors. Incidence of AF did not largely alter the association of renal dysfunction and cardiovascular outcomes.
AB - Aims: Renal dysfunction is a risk factor for cardiovascular disease, including atrial fibrillation (AF) and mortality. However, the exact pathobiology linking different renal dysfunction measures, such as albumin excretion or glomerular filtration rate (GFR), to cardiovascular- and AF risk are unclear. In this study, we investigated the association of several renal function measures and incident AF, and whether the relation between renal measures and outcomes is modified by AF.Methods and results: We examined 8265 individuals (age 49 ± 13 years, 50% women) included in the PREVEND study. We used albumin excretion (morning void and 24-h urine samples), serum creatinine, cystatin C, and Cystatin C-based, creatinine-based, and creatinine-cystatin C-based GFR as renal function measures; results: During a follow-up of 9.8 ± 2.3 years, 267 participants (3.2%) developed AF. In the multivariate-adjusted model, GFR, estimated by creatinine, cystatin C, or the combination was not associated with incident AF. However, increased albumin excretion was strongly associated with incident AF; urine albumin concentration and excretion (HRmorning void 1.10, P = 0.005 and HR24-hr collection 1.05, P = 0.033) and albumin creatinine ratio (HRmorning void 1.05, P = 0.010 and HR24-hr collection 1.06, P < 0.001). Interaction terms of incident AF and renal measures were not significant for incident cerebrovascular events, peripheral vascular events, ischemic heart disease, heart failure, and mortality.Conclusion: In this community-based cohort, increased albumin excretion, and not GFR, was associated with incident AF, independent of established cardiovascular risk factors. Incidence of AF did not largely alter the association of renal dysfunction and cardiovascular outcomes.
KW - Adult
KW - Albuminuria/diagnosis
KW - Atrial Fibrillation/diagnosis
KW - Biomarkers/blood
KW - Creatinine/blood
KW - Cystatin C/blood
KW - Female
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Incidence
KW - Kaplan-Meier Estimate
KW - Kidney Diseases/diagnosis
KW - Kidney/physiopathology
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Netherlands/epidemiology
KW - Predictive Value of Tests
KW - Prognosis
KW - Proportional Hazards Models
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Renal function
KW - Epidemiology
KW - Atrial fibrillation
KW - Mortality
KW - Risk factor
UR - http://www.scopus.com/inward/record.url?scp=85025812008&partnerID=8YFLogxK
U2 - 10.1093/europace/euw373
DO - 10.1093/europace/euw373
M3 - Article
C2 - 28108549
SN - 1099-5129
VL - 19
SP - 1930
EP - 1936
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
IS - 12
ER -