Previous studies have shown that patients with advanced chronic kidney disease (CKD), including those on dialysis, have an increased risk for atrial fibrillation (AF). There are limited data, however, on the prevalence and risk factors of AF in less severe CKD, which is substantially more common than end-stage renal disease. Over 25 million adults in the United States have CKD; most of them are in the early stages of CKD. Understanding the prevalence and risk factors of AF in these patients has important public health, epidemiological, and clinical implications.

Important New Data

New research suggests that patients with CKD, even in its early stages, have similar rates of AF. In a study published in the June 2010 American Heart Journal, my colleagues and I at Wake Forest University attempted to better define the link between CKD and AF using data from the Chronic Renal Insufficiency Cohort (CRIC), a study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the NIH. We found that nearly 20% of study participants with early stages of CKD had evidence of AF, a rate similar to what has been reported among patients with end-stage renal disease. This rate is also two to three times the AF rates reported in the general population using similar AF detection methods.

Another key finding from our investigation was that the risk factors for AF in patients with CKD did not appear to be the same as those seen in the general population. Contrary to the general population, the following were not significant risk factors for AF in CKD patients:

Race/ethnicity

Hypertension

Diabetes

Obesity

Assessing the Impact

Our results from the CRIC study exposed a new population of potentially millions of patients who were previously thought of as being at low risk for AF. This means that clinicians must make efforts to detect AF as early as possible in individuals with CKD so as to reduce their risk of AF complications such as stroke.

“Clinicians must make efforts to detect AF as early as possible in individuals with CKD so as to reduce the risk of AF complications such as stroke.”

The high rate of AF seen in patients with early stages of CKD suggests that the processes that influence the development of AF occur early in the course of CKD. The importance of learning about these processes comes in utilizing strategies for preventing AF.

Wanted: More Research

Based on the results of our study, it is clear that AF is a common problem in patients with CKD, regardless of the severity of kidney disease. Detecting AF early is critical, but it would also be helpful to understand how aggressive physicians should be with treatment so that outcomes can improve. It would behoove us to develop a separate set of AF predictors that are specifically designed for patients with CKD. This may ultimately result in effective, earlier detection and treatment for this serious risk factor for stroke, and may decrease mortality rates in those with CKD.

 

References

Soliman EZ, Prineas RJ, Go AS, et al. Chronic kidney disease and prevalent atrial fibrillation: the chronic renal insufficiency cohort (CRIC). Am Heart J. 2010;159:1102-1107. Abstract available at:http://www.ahjonline.com/article/S0002-8703(10)00253-X/abstract.

Chamberlain AM, Agarwal SK, Ambrose M, Folsom AR, Soliman EZ, Alonso A. Metabolic syndrome and incidence of atrial fibrillation among blacks and whites in the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J. 2010;159:850-856.

Meschia JF, Merrill P, Soliman EZ, et al. Racial disparities in awareness and treatment of atrial fibrillation: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke. 2010;41:581-587.

Horio T, Iwashima Y, Kamide K, et al. Chronic kidney disease as an independent risk factor for new-onset atrial fibrillation in hypertensive patients. J Hypertens. 2010;28:1738-1744.