Open AccessAssociation of atrial fibrillation and clinical outcomes in adults with chronic kidney disease: A propensity score-matched analysis
Author(s) -
Chunxia Zhang,
Jingli Gao,
Yifan Guo,
Aijun Xing,
Pengpeng Ye,
Yuntao Wu,
Shouling Wu,
Yang Luo
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0230189
Subject(s) - medicine , atrial fibrillation , stroke (engine) , hazard ratio , kidney disease , renal function , confidence interval , population , confounding , cardiology , mechanical engineering , environmental health , engineering
Objective Atrial fibrillation (AF) is associated with adverse outcomes in the general population, but its impact on patients with chronic kidney disease (CKD) remains unclear. In this study, we assessed the association between AF and risks of all-cause mortality and stroke in Chinese adults with CKD. Methods We enrolled adults aged 45 years or older with CKD (defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m 2 and/or proteinuria identified using the urine dipstick method) from the Kailuan study between 2008 and 2014. AF was identified by 12-lead electrocardiography or hospital discharge diagnostic codes. Mortality data were collected from the provincial vital statistics, and physician-diagnosed ischemic or hemorrhagic stroke was confirmed in the biennial interview. Results Among the 21587 CKD adults, 216 patients were identified with AF, the median follow-up duration was 5.21 years (5.69 ± 1.96 years); During follow-up, there were 70 cases of death, and 16 cases of ischemic stroke and 6 cases of hemorrhagic stroke in the participants with AF in comparison with 2572 cases of death and 656 cases of ischemic stroke and 184 cases of hemorrhagic stroke among the participants without AF. After adjustment for potential confounders, AF was associated with an 86% increase in the rate of death (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.33–2.59, P<0.001), a 104% (HR, 2.04; 95% CI, 1.09–3.83, P = 0.026) and 325% (HR, 4.25; 95% CI, 1.74–10.36, P = 0.001) increase in the rate of ischemic stroke and hemorrhagic stroke, respectively. These associations were still consistent and strong after propensity score-matched analysis. Conclusion Our study shows that AF is independently associated with increased risk of all-cause mortality, ischemic and hemorrhagic stroke in Chinese CKD adults. Future studies are required to elucidate the physiological mechanisms underlying this association.