Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Original ArticlesChronic Kidney Disease
You have accessRestricted Access

Prevalence of Atrial Fibrillation and Its Predictors in Nondialysis Patients with Chronic Kidney Disease

Wanwarat Ananthapanyasut, Sirikarn Napan, Earl H. Rudolph, Tasma Harindhanavudhi, Husam Ayash, Kelly E. Guglielmi and Edgar V. Lerma
CJASN February 2010, 5 (2) 173-181; DOI: https://doi.org/10.2215/CJN.03170509
Wanwarat Ananthapanyasut
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sirikarn Napan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Earl H. Rudolph
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tasma Harindhanavudhi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Husam Ayash
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kelly E. Guglielmi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Edgar V. Lerma
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

Abstract

Background and objectives: Chronic kidney disease (CKD) increases systemic inflammation, which is implicated in development and maintenance of atrial fibrillation (AF); therefore, we hypothesized that the prevalence of AF would be increased among nondialysis patients with CKD. This study also reports independent predictors of the presence of AF in this population.

Design, setting, participants, & measurements: A retrospective, cross-sectional analysis of 1010 consecutive nondialysis patients with CKD from two community-based hospitals was conducted. Estimated GFRs (eGFRs) were calculated using the Modification of Diet in Renal Disease (MDRD) equation. Multivariate logistic regression was used to determine independent predictors.

Results: Of 1010 nondialysis patients with CKD, 214 (21.2%) had AF. Patients with AF were older than patients without AF (76 ± 11 versus 63 ± 15 yr). The prevalence of AF among white patients (42.7%) was higher than among black patients (12.7%) or other races (5.7%). In multivariate analyses, age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure were identified as independent predictors of the presence of AF. Although serum high-sensitivity C-reactive protein levels were elevated in our population (5.2 ± 7.4 mg/L), levels did not correlate with the presence of AF or with eGFR. Finally, eGFR did not correlate with the presence of AF in our population.

Conclusions: The prevalence of AF was increased in our population, and independent predictors were age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice (1). Cardiac comorbidities that are associated with AF include hypertension, coronary artery disease (CAD), valvular heart disease (VHD), congestive heart failure (CHF), cardiomyopathy, pericarditis, congenital heart disease (CHD), and cardiac surgery (2–9). Noncardiac comorbidities that are associated with AF include acute pulmonary embolism, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, hyperthyroidism, and obesity (10–14).

Evidence suggests that inflammation is involved in the pathogenesis of AF (15–20). For example, AF after cardiac surgery is associated with proinflammatory cytokine and complement activation (16,19). Moreover, patients with refractory lone AF have inflammatory infiltrates, myocyte necrosis, and fibrosis on biopsy (18). Several studies also reported elevated serum high-sensitivity C-reactive protein (hsCRP) levels in patients with AF (15–17,20).

Evidence suggests that inflammation is associated with renal dysfunction (21–24). Proposed mechanisms include decreased proinflammatory cytokine clearance, endotoxemia, oxidative stress, and reduced antioxidant levels (23,24). Moreover, hsCRP levels are higher among elderly patients with renal insufficiency (24). In hemodialysis (HD) patients with ESRD, hsCRP, IL-6, and fibrinogen levels are elevated (21,22).

HD patients with ESRD have an increased prevalence of AF; however, prevalence among nondialysis patients with CKD has not been investigated (25–30). Because CKD promotes inflammation, which promotes AF, we hypothesized the prevalence of AF would be increased among nondialysis patients with CKD. This study reports the prevalence and independent predictors of the presence of AF in a nondialysis population with CKD.

Materials and Methods

We conducted a retrospective, cross-sectional analysis of consecutive inpatients and outpatients at two community-based teaching hospitals between January and July 2008. Patients had CKD as defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI): (1) Evidence of structural or functional kidney damage for ≥3 mo, with or without decreased GFR, manifest by markers of kidney damage (including blood, urine, and imaging abnormalities) or (2) GFR <60 ml/min per 1.73 m2 for ≥3 mo with or without evidence of kidney damage (31).

CKD was stratified as stage 1 (kidney damage, GFR ≥90), stage 2 (GFR 60 to 89), stage 3 (GFR 30 to 59), stage 4 (GFR 15 to 29), or stage 5 (kidney failure, GFR <15 or dialysis) (31). Patients who were in acute renal failure, in a postoperative period, or receiving dialysis were excluded. Moreover, we hypothesized that decreased GFR was associated with inflammation; therefore, patients with stage 1 CKD were also excluded.

Estimated GFR (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation: eGFR (ml/min per 1.73 m2) = 1.86 × serum creatinine−1.154 × age−0.203 × 0.742 (if female) × 1.210 (if black) (31,32). Patients with AF were identified on the basis of medical record documentation and/or electrocardiographic evidence and classified as paroxysmal, persistent, or permanent. Patients with hypertension were identified on the basis of medical record documentation, and mean systolic (SBP) and diastolic BP (DBP) were systematically calculated from five measurements. Other comorbid conditions were identified on the basis of medical record documentation. Left ventricular (LV) hypertrophy (LVH) was defined as intraventricular septum and/or posterior wall thickness >11 mm. Left atrial (LA) diameter and LV ejection fraction (LVEF) were derived from echocardiographic data. LV systolic dysfunction was defined as LVEF <50%. Similar to a previous study, VHD likely to be associated with AF was defined as any degree of mitral stenosis or moderate to severe mitral regurgitation, aortic stenosis, or aortic regurgitation (26).

Data from patients with and without AF were compared using χ2 and Wilcoxon rank-sum analyses. Univariate linear regression examined the relationship between eGFR and hsCRP levels. Univariate logistic regression identified variables that were associated with the presence of AF, and those with P < 0.1 were included in multivariate analysis using a backward stepwise logistic regression model with a stay criterion of 0.10. A multiplicative model including age-race interaction terms adjusted for significant variables estimated the effect of age (stratified as <50, 50 to 59, 60 to 69, 70 to 79, and ≥80 yr of age) and race (white versus nonwhite) on the prevalence of AF. Odds ratios and 95% confidence intervals were calculated using nonwhite patients who were younger than 50 yr (lowest prevalence of AF) as the denominator. P < 0.05 was considered statistically significant. Statistics were calculated using Stata statistics software (Stata Corp., College Station, TX).

Results

Prevalence of AF

Of 1010 nondialysis patients with CKD, 214 (21.2%) had AF, classified as permanent (38.8%), persistent (18.2%), or paroxysmal (43.0%). The prevalence of AF stratified by age, gender, and race is summarized in Table 1. When stratified by age, the prevalence was 8.1% among those who were younger than 65, 31.6% among those who were aged ≥65, and 45.8% among those who were aged ≥80 yr. When stratified by gender, the prevalence was similar among men (20.6%) and women (21.8%). When stratified by race, the prevalence was 42.7% among white patients, 12.7% among black patients, and 5.7% among other races. When stratified by age and race, the prevalence of AF increased with age, irrespective of race, and was higher among white patients of a given age group (Figure 1). Moreover, the adjusted odds ratio was highest among white patients who were aged ≥80 yr and least among nonwhite patients who were younger than 50 yr (Table 2). When patients with known risk factors for development of AF (e.g., CAD, VHD, CHF, COPD, hyperthyroidism) were excluded from analysis, the prevalence was 6.3% but still increased with age with 3.4% among those who were younger than 65, 10.4% among those who were aged ≥65, and 18.5% among those who were aged ≥80 yr. When stratified by CKD stage, the prevalences were 17.9, 25.2, 20.8, and 8.0% for stages 2 through 5, respectively (Table 1).

View this table:
  • View inline
  • View popup
Table 1.

Prevalence of atrial fibrillation in nondialysis patients with CKD

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Prevalence of atrial fibrillation among nondialysis patients with CKD stratified by age and race.

View this table:
  • View inline
  • View popup
Table 2.

Effect of age and race on the presence of AF among non-dialysis CKD patients

Demographic and Clinical Characteristics

Demographic and clinical characteristics of nondialysis patients who had CKD with and without AF are summarized in Table 3. Patients with AF were on average older than patients without AF (76 ± 11 versus 63 ± 15 yr; P < 0.001). The proportions of male and female patients with AF (50.0% male versus 50.0% female) and patients without AF (51.9% male versus 48.1% female) were similar. Moreover, the proportion of white race was higher among patients with than without AF (66.8 versus 24.1%; P < 0.001), the proportion of black race was lower among patients with than without AF (27.6 versus 51.1%; P < 0.001), and the proportion of other races was also lower among patients with than without AF (5.6 versus 24.8%; P < 0.001).

View this table:
  • View inline
  • View popup
Table 3.

Demographic and clinical characteristics of nondialysis patients who had CKD with and without AF

Overall, diabetic nephropathy was the most common known cause of CKD in our nondialysis population with CKD (46.0%), followed by hypertensive nephrosclerosis (25.4%). Of known causes of CKD, only ischemic nephropathy occurred more frequently among patients with AF. Comorbidities that occurred more frequently among patients with AF included diabetes, CHF, CAD, VHD, peripheral vascular disease (PVD), cerebrovascular accident (CVA), COPD, and hyperthyroidism (Table 3). Patients with AF also had lower SBP and DBP measurements than patients without AF (127/67 ± 17/10 versus 138/73 ± 19/11 mmHg; P < 0.001 each). AF patients had higher eGFRs than patients without AF (36.5 ± 13.9 versus 33.4 ± 16.5 ml/min per 1.73 m2; P = 0.004). Finally, patients with AF were treated more frequently with angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs). Patients with AF also tended to be treated more frequently with β blockers, whereas statin treatment was similar in both groups.

Echocardiographic and Laboratory Data

Echocardiographic data were obtained from 621 of 1010 nondialysis patients with CKD (Table 4). Patients with AF had lower LVEFs (50.7 ± 15.6 versus 56.8 ± 13.6%; P < 0.001), increased frequency of LV systolic dysfunction (37.2 versus 20.0%; P < 0.001), increased LA diameter (46.4 ± 25.4 versus 40.8 ± 6.5 mm; P < 0.001), and increased frequency of VHD (26.6 versus 6.0%; P < 0.001) than patients without AF; however, there was no difference in frequency of LVH or pulmonary artery systolic pressure between groups.

View this table:
  • View inline
  • View popup
Table 4.

Echocardiographic data of nondialyhsis patients who have CKD with and without AF

Laboratory data were obtained from all nondialysis patients with CKD (Table 5). Patients with AF had lower serum potassium, calcium, phosphorus, creatinine, albumin, cholesterol, and triglyceride levels and higher serum bicarbonate levels. Levels of hsCRP were obtained from 76 of 1010 nondialysis patients with CKD. Although data were limited, average hsCRP levels were elevated above the reference value (<3.0 mg/L) of our nondialysis population with CKD. Moreover, levels tended to be lower in patients with than without AF (4.3 ± 5.7 versus 5.7 ± 8.2 mg/dl; P = 0.420), although not statistically significant. Finally, to examine the potential relationship between impaired renal function and inflammation, we compared eGFRs with hsCRP levels; however, there was no correlation in our population (Figure 2).

View this table:
  • View inline
  • View popup
Table 5.

Laboratory data of nondialysis patients who had CKD with and without AF

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

eGFR does not correlate with hsCRP levels in nondialysis patients with CKD. The correlation coefficient is R = −0.36, P = 0.757.

Independent Predictors of AF

Clinical, echocardiographic, and laboratory variables that were associated with the presence of AF in our nondialysis population with CKD identified by univariate logistic regression analyses are summarized in Table 6. Significant variables that were positively associated with AF included age, white race, dyslipidemia, CHF, CAD, PVD, CVA, COPD, hyperthyroidism, increasing LA diameter, VHD, and eGFR. Significant variables that were negatively associated with AF included diabetes, mean SBP and DBP, LVEF, serum potassium, calcium, phosphorus, and albumin levels. Multivariate analysis of significant variables that were identified by univariate logistic regression analyses identified age, white race, increasing LA diameter, lower SBP, and CHF as independent predictors of the presence of AF in our population (Table 7).

View this table:
  • View inline
  • View popup
Table 6.

Univariate logistic regression analyses for the presence of AF among nondialysis patients with CKD

View this table:
  • View inline
  • View popup
Table 7.

Multivariate logistic regression analyses for the presence of AF among nondialysis patients with CKD

Discussion

Although the prevalence of AF was increased in our nondialysis population with CKD, we did not find an association between AF and inflammatory biomarkers or eGFR. The prevalence of AF in our population (21.2%) was greater than estimates in the general population (1.5 to 6.2%) (1,33–36). The prevalence of AF increased with age and was highest among those who were aged ≥80 yr. Patients with AF were older than patients without AF, and the prevalence among patients who were aged ≥65 yr (31.6%) was greater than estimates for the same age group in the general population (5.9%). Studies that estimated the prevalence of AF in HD patients with ESRD (5.4 to 27.0%) vary likely because of different enrollment criteria (25–29). For example, in one HD population, the prevalence of AF was 27.0%, whereas in another that excluded rheumatic VHD and paroxysmal AF the prevalence was 13.6%, whereas in another that included only permanent AF the prevalence was 5.4% (26,27,29). For comparison with our population, we calculated that, without exclusions, the prevalence of AF was 21.2% (versus 27%); when VHD and paroxysmal AF were excluded, it was 10.1% (versus 13.6%); and when only permanent AF was included, it was 8.2% (versus 5.4%). Therefore, the prevalence of AF in our population (21.2%) is at least triple that reported for the general population (1.5 to 6.2%) and within the broad range reported among various HD populations with ESRD (5.4 to 27.0%).

In Framingham Heart Study patients, the prevalence of AF in the general population was higher among men than women (7:1 ratio) (37,38). In our nondialysis population with CKD, the prevalences of AF among male (20.6%) and female (21.8%) patients were similar, as were the proportions of male and female patients with and without AF. With respect to race, studies that estimated the prevalence of AF vary considerably (34,35,38–41). A higher electrocardiographic prevalence of AF was reported in white (7.8%) compared with black (2.5%) hospitalized patients (41). In another study, a higher prevalence of heart failure–associated AF was reported in white (38.3%) compared with black (19.7%) patients (40). Similarly, the prevalence of AF in our population was higher in white (42.7%) compared with black (12.7%) patients or patients of other races (5.7%). These racial differences may be due to genetic polymorphisms that code for intrinsic differences in atrial membrane stability and/or conduction pathways, resulting in different susceptibilities to development of AF (40). When stratified by age and race, the prevalence of AF increased with age, irrespective of race (Figure 1). It is interesting that, when stratified by CKD stage, there was no notable trend.

Clearly, our nondialysis population with CKD is elderly; has a high prevalence of atherosclerotic, diabetic, and hypertensive disease; and is more prone to inflammatory influences and development of AF. Among our population, we found that comorbidities including diabetes, CHF, CAD, VHD, PVD, CVA, COPD, and hyperthyroidism occurred more frequently among patients with AF. Not surprising, diabetic nephropathy (46.0%) and hypertensive nephrosclerosis (25.4%) were common in our nondialysis population with CKD; however, only ischemic nephropathy occurred more frequently among patients with AF. Diabetes was negatively associated with AF by univariate analysis, possibly because of higher frequency of ACEI and/or ARB use among patients with AF. The higher frequency of ACEI and/or ARB use among patients with AF may also reflect their use in treatment of CHF (42,43). Moreover, ACEIs and/or ARBs have been shown to prevent AF, especially among those with systolic LV dysfunction or LVH.

Among our nondialysis population with CKD, echocardiographic data revealed that patients with AF have significantly lower LVEF, increased LA diameter, and increased frequencies of VHD and LV systolic dysfunction; however, there was no difference in frequency of LVH or pulmonary artery SBP between groups. These findings are partially consistent with a study that reported that LVEF and LVH were associated with AF (44). Laboratory data revealed that patients with AF have lower serum potassium, calcium, phosphorus, creatinine, albumin, cholesterol, and triglyceride levels and higher serum bicarbonate levels. We are not aware of any studies with similar data; however, although the mean concentrations of the proarrhythmogenic electrolytes calcium and potassium were different between groups, they were within the range of normality and therefore likely not related to AF in our population.

We hypothesized that the prevalence of AF would be increased among nondialysis patients with CKD because CKD promotes inflammation, which promotes AF. We reasoned that hsCRP levels might be elevated and associated with decreased eGFR in this population. Although hsCRP levels were elevated, there was no association with eGFR (Figure 2). The extent to which renal dysfunction estimated by GFR is related to inflammatory biomarkers is controversial. Some studies reported hsCRP levels are elevated and increased with progression of CKD, whereas others reported no correlation (24,45,46). Several studies also reported an association between elevated hsCRP levels and AF and that higher baseline levels may predict development of AF (15–17,20). Although hsCRP levels were elevated in our nondialysis population with CKD, comparison between patients with and without AF proved difficult because of considerable variation in serum levels. These findings question the utility of hsCRP as an indicator of inflammation in nondialysis patients with CKD and its relevance to AF.

In our nondialysis population with CKD, multivariate analysis found that age and white race are independent predictors of the presence of AF. Moreover, the prevalence of AF was higher among white patients of a given age group, increased with each decade, and was highest among patients who were aged ≥80 yr. That age and white race are independent predictors of the presence of AF is not surprising given the increasing prevalence with age among white patients. CHF and increasing LA diameter were also independent predictors of the presence of AF in our population. Similarly, others have reported that CHF and increasing LA diameter are risk factors for developing AF (7,37,39,44). Overall, our study suggests that the high prevalence of AF in our nondialysis population with CKD may be due to the presence of numerous cardiovascular comorbidities rather than reduced GFR.

Whereas hypertension is associated with AF in the general population, this is not necessarily the case among HD populations with ESRD (7,26,27,37,39). In our nondialysis population with CKD, hypertension was negatively associated with and not a predictor of AF. Rather, lower SBP was an independent predictor of AF in our population. The prevalence of hypertension was >90% in our population, leaving relatively few normotensive patients for comparison, perhaps contributing to these findings. Moreover, although the association between lower SBP and AF is difficult to interpret, it is likely not due to cardiac inefficiency, because mean LVEF, although statistically different between groups, was within the normal range in both groups. As expected, patients with AF had increased prevalence of cardiovascular comorbidities, including CHF and CAD, and accordingly received more evidence-based medications including ACEIs and ARBs; however, β blocker use was similar between groups and likely noncontributory (43,47,48). Overall, the potential relationship between BP and AF among nondialysis patients with CKD should be further examined in longitudinal studies.

CAD and VHD are associated with development of AF in population-based studies (7,37–39); however, in our population, they failed to reach significance by multivariate analysis even when LA diameter was integrated into our statistical model. Perhaps CAD and VHD influence development of AF by mechanisms other than increased LA diameter. Similarly, diabetes and hyperthyroidism are associated with development of AF; however, they failed to reach significance by multivariate analysis (7,37). Moreover, COPD was not an independent predictor of AF in our nondialysis population with CKD, similar to one study but contrary to another (37,39). Finally, decreased LVEF and LVH have been reported as predictors of AF but failed to reach significance in our nondialysis population with CKD (44).

With respect to limitations, this study was designed to determine independent predictors of the presence of AF in a nondialysis population with CKD and does not make comparisons with a control population with normal renal function. Also, CKD and AF are chronic illnesses, often with unidentifiable times of onset. The extent to which the prevalence of AF in our population can be attributed to CKD is also not clear because other comorbidities likely contribute. Moreover, the retrospective design does not allow determination of cause-and-effect relationships. We can only describe the prevalence, demographic and clinical characteristics, and identify independent predictors of the presence of AF in this population. Moreover, hsCRP samples were collected irrespective of coexisting medical conditions and may not entirely reflect inflammatory status with respect to renal dysfunction. This limits conclusions that can be drawn concerning hsCRP and inflammation and its association with AF in this population. We should also note that increasing LA diameter does not necessarily reflect LVH. Finally, our nondialysis population with CKD includes a substantial number of inpatients who typically have a higher prevalence of AF and a greater number of comorbidities than the general population; therefore, caution must be exercised when making comparisons with the general population. Larger multicenter, prospective studies would be ideal to clarify the relationship among renal dysfunction, inflammation, and AF.

Conclusions

We observed a high prevalence of AF in our nondialysis population with CKD, and age, white race, increasing LA diameter, lower SBP, and CHF were identified as independent predictors of the presence of AF. Notably, hsCRP levels were elevated in our population; however, levels did not correlate with the presence of AF or the degree of renal dysfunction estimated by GFR. Finally, eGFR did not correlate with the presence of AF in our population.

Disclosures

None.

Acknowledgments

We thank Dr. Joseph Oyama for reviewing the manuscript.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • Access to UpToDate on-line is available for additional clinical information at http://www.cjasn.org/

  • Received May 12, 2009.
  • Accepted October 28, 2009.
  • Copyright © 2010 by the American Society of Nephrology

References

  1. ↵
    1. Go AS,
    2. Hylek EM,
    3. Phillips KA,
    4. Chang Y,
    5. Henault LE,
    6. Selby JV,
    7. Singer DE
    : Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285: 2370–2375, 2001
    OpenUrlCrossRefPubMed
  2. ↵
    1. Carson PE,
    2. Johnson GR,
    3. Dunkman WB,
    4. Fletcher RD,
    5. Farrell L,
    6. Cohn JN
    : The influence of atrial fibrillation on prognosis in mild to moderate heart failure: The V-HeFT Studies. The V-HeFT VA Cooperative Studies Group. Circulation 87: VI102–VI110, 1993
    OpenUrlPubMed
  3. ↵
    1. Dries DL,
    2. Exner DV,
    3. Gersh BJ,
    4. Domanski MJ,
    5. Waclawiw MA,
    6. Stevenson LW
    : Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: A retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 32: 695–703, 1998
    OpenUrlCrossRefPubMed
  4. ↵
    1. Maisel WH,
    2. Rawn JD,
    3. Stevenson WG
    : Atrial fibrillation after cardiac surgery. Ann Intern Med 135: 1061–1073, 2001
    OpenUrlCrossRefPubMed
  5. ↵
    1. Rathore SS,
    2. Berger AK,
    3. Weinfurt KP,
    4. Schulman KA,
    5. Oetgen WJ,
    6. Gersh BJ,
    7. Solomon AJ
    : Acute myocardial infarction complicated by atrial fibrillation in the elderly: Prevalence and outcomes. Circulation 101: 969–974, 2000
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Diker E,
    2. Aydogdu S,
    3. Ozdemir M,
    4. Kural T,
    5. Polat K,
    6. Cehreli S,
    7. Erdogan A,
    8. Goksel S
    : Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease. Am J Cardiol 77: 96–98, 1996
    OpenUrlCrossRefPubMed
  7. ↵
    1. Krahn AD,
    2. Manfreda J,
    3. Tate RB,
    4. Mathewson FA,
    5. Cuddy TE
    : The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med 98: 476–484, 1995
    OpenUrlCrossRefPubMed
  8. ↵
    1. Robinson K,
    2. Frenneaux MP,
    3. Stockins B,
    4. Karatasakis G,
    5. Poloniecki JD,
    6. McKenna WJ
    : Atrial fibrillation in hypertrophic cardiomyopathy: A longitudinal study. J Am Coll Cardiol 15: 1279–1285, 1990
    OpenUrlCrossRefPubMed
  9. ↵
    1. Wong CK,
    2. White HD,
    3. Wilcox RG,
    4. Criger DA,
    5. Califf RM,
    6. Topol EJ,
    7. Ohman EM
    : New atrial fibrillation after acute myocardial infarction independently predicts death: The GUSTO-III experience. Am Heart J 140: 878–885, 2000
    OpenUrlCrossRefPubMed
  10. ↵
    1. Buch P,
    2. Friberg J,
    3. Scharling H,
    4. Lange P,
    5. Prescott E
    : Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J 21: 1012–1016, 2003
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Gami AS,
    2. Pressman G,
    3. Caples SM,
    4. Kanagala R,
    5. Gard JJ,
    6. Davison DE,
    7. Malouf JF,
    8. Ammash NM,
    9. Friedman PA,
    10. Somers VK
    : Association of atrial fibrillation and obstructive sleep apnea. Circulation 110: 364–367, 2004
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Goldhaber SZ,
    2. Visani L,
    3. De Rosa M
    : Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353: 1386–1389, 1999
    OpenUrlCrossRefPubMed
  13. ↵
    1. Woeber KA
    : Thyrotoxicosis and the heart. N Engl J Med 327: 94–98, 1992
    OpenUrlCrossRefPubMed
  14. ↵
    1. Wang TJ,
    2. Parise H,
    3. Levy D,
    4. D'Agostino RB Sr.,
    5. Wolf PA,
    6. Vasan RS,
    7. Benjamin EJ
    : Obesity and the risk of new-onset atrial fibrillation. JAMA 292: 2471–2477, 2004
    OpenUrlCrossRefPubMed
  15. ↵
    1. Aviles RJ,
    2. Martin DO,
    3. Apperson-Hansen C,
    4. Houghtaling PL,
    5. Rautaharju P,
    6. Kronmal RA,
    7. Tracy RP,
    8. Van Wagoner DR,
    9. Psaty BM,
    10. Lauer MS,
    11. Chung MK
    : Inflammation as a risk factor for atrial fibrillation. Circulation 108: 3006–3010, 2003
    OpenUrlAbstract/FREE Full Text
  16. ↵
    1. Bruins P,
    2. te Velthuis H,
    3. Yazdanbakhsh AP,
    4. Jansen PG,
    5. van Hardevelt FW,
    6. de Beaumont EM,
    7. Wildevuur CR,
    8. Eijsman L,
    9. Trouwborst A,
    10. Hack CE
    : Activation of the complement system during and after cardiopulmonary bypass surgery: Postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 96: 3542–3548, 1997
    OpenUrlAbstract/FREE Full Text
  17. ↵
    1. Chung MK,
    2. Martin DO,
    3. Sprecher D,
    4. Wazni O,
    5. Kanderian A,
    6. Carnes CA,
    7. Bauer JA,
    8. Tchou PJ,
    9. Niebauer MJ,
    10. Natale A,
    11. Van Wagoner DR
    : C-reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanisms and persistence of atrial fibrillation. Circulation 104: 2886–2891, 2001
    OpenUrlAbstract/FREE Full Text
  18. ↵
    1. Frustaci A,
    2. Chimenti C,
    3. Bellocci F,
    4. Morgante E,
    5. Russo MA,
    6. Maseri A
    : Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96: 1180–1184, 1997
    OpenUrlAbstract/FREE Full Text
  19. ↵
    1. Gaudino M,
    2. Andreotti F,
    3. Zamparelli R,
    4. Di Castelnuovo A,
    5. Nasso G,
    6. Burzotta F,
    7. Iacoviello L,
    8. Donati MB,
    9. Schiavello R,
    10. Maseri A,
    11. Possati G
    : The −174G/C interleukin-6 polymorphism influences postoperative interleukin-6 levels and postoperative atrial fibrillation: Is atrial fibrillation an inflammatory complication? Circulation 108 [Suppl 1]: II195–II199, 2003
    OpenUrlPubMed
  20. ↵
    1. Gedikli O,
    2. Dogan A,
    3. Altuntas I,
    4. Altinbas A,
    5. Ozaydin M,
    6. Akturk O,
    7. Acar G
    : Inflammatory markers according to types of atrial fibrillation. Int J Cardiol 120: 193–197, 2007
    OpenUrlCrossRefPubMed
  21. ↵
    1. Bologa RM,
    2. Levine DM,
    3. Parker TS,
    4. Cheigh JS,
    5. Serur D,
    6. Stenzel KH,
    7. Rubin AL
    : Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients. Am J Kidney Dis 32: 107–114, 1998
    OpenUrlCrossRefPubMed
  22. ↵
    1. Owen WF,
    2. Lowrie EG
    : C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 54: 627–636, 1998
    OpenUrlCrossRefPubMed
  23. ↵
    1. Panichi V,
    2. Migliori M,
    3. De Pietro S,
    4. Taccola D,
    5. Bianchi AM,
    6. Norpoth M,
    7. Metelli MR,
    8. Giovannini L,
    9. Tetta C,
    10. Palla R
    : C reactive protein in patients with chronic renal diseases. Ren Fail 23: 551–562, 2001
    OpenUrlCrossRefPubMed
  24. ↵
    1. Shlipak MG,
    2. Fried LF,
    3. Crump C,
    4. Bleyer AJ,
    5. Manolio TA,
    6. Tracy RP,
    7. Furberg CD,
    8. Psaty BM
    : Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 107: 87–92, 2003
    OpenUrlAbstract/FREE Full Text
  25. ↵
    1. Atar I,
    2. Konas D,
    3. Acikel S,
    4. Kulah E,
    5. Atar A,
    6. Bozbas H,
    7. Gulmez O,
    8. Sezer S,
    9. Yildirir A,
    10. Ozdemir N,
    11. Muderrisoglu H,
    12. Ozin B
    : Frequency of atrial fibrillation and factors related to its development in dialysis patients. Int J Cardiol 106: 47–51, 2006
    OpenUrlCrossRefPubMed
  26. ↵
    1. Genovesi S,
    2. Pogliani D,
    3. Faini A,
    4. Valsecchi MG,
    5. Riva A,
    6. Stefani F,
    7. Acquistapace I,
    8. Stella A,
    9. Bonforte G,
    10. DeVecchi A,
    11. DeCristofaro V,
    12. Buccianti G,
    13. Vincenti A
    : Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. Am J Kidney Dis 46: 897–902, 2005
    OpenUrlCrossRefPubMed
  27. ↵
    1. Vazquez E,
    2. Sanchez-Perales C,
    3. Borrego F,
    4. Garcia-Cortes MJ,
    5. Lozano C,
    6. Guzman M,
    7. Gil JM,
    8. Borrego MJ,
    9. Perez V
    : Influence of atrial fibrillation on the morbido-mortality of patients on hemodialysis. Am Heart J 140: 886–890, 2000
    OpenUrlCrossRefPubMed
  28. ↵
    1. Fabbian F,
    2. Catalano C,
    3. Lambertini D,
    4. Tarroni G,
    5. Bordin V,
    6. Squerzanti R,
    7. Gilli P,
    8. Di Landro D,
    9. Cavagna R
    : Clinical characteristics associated to atrial fibrillation in chronic hemodialysis patients. Clin Nephrol 54: 234–239, 2000
    OpenUrlPubMed
  29. ↵
    1. Abe S,
    2. Yoshizawa M,
    3. Nakanishi N,
    4. Yazawa T,
    5. Yokota K,
    6. Honda M,
    7. Sloman G
    : Electrocardiographic abnormalities in patients receiving hemodialysis. Am Heart J 131: 1137–1144, 1996
    OpenUrlCrossRefPubMed
  30. ↵
    1. Genovesi S,
    2. Vincenti A,
    3. Rossi E,
    4. Pogliani D,
    5. Acquistapace I,
    6. Stella A,
    7. Valsecchi MG
    : Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. Am J Kidney Dis 51: 255–262, 2008
    OpenUrlCrossRefPubMed
  31. ↵
    K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 39: S1–266, 2002
    OpenUrlCrossRefPubMed
  32. ↵
    1. Levey AS,
    2. Bosch JP,
    3. Lewis JB,
    4. Greene T,
    5. Rogers N,
    6. Roth D
    : A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130: 461–470, 1999
    OpenUrlCrossRefPubMed
  33. ↵
    1. Langenberg M,
    2. Hellemons BS,
    3. van Ree JW,
    4. Vermeer F,
    5. Lodder J,
    6. Schouten HJ,
    7. Knottnerus JA
    : Atrial fibrillation in elderly patients: Prevalence and comorbidity in general practice. BMJ 313: 1534, 1996
    OpenUrlFREE Full Text
  34. ↵
    1. Lip GY,
    2. Golding DJ,
    3. Nazir M,
    4. Beevers DG,
    5. Child DL,
    6. Fletcher RI
    : A survey of atrial fibrillation in general practice: The West Birmingham Atrial Fibrillation Project. Br J Gen Pract 47: 285–289, 1997
    OpenUrlAbstract/FREE Full Text
  35. ↵
    1. Lok NS,
    2. Lau CP
    : Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly. Int J Cardiol 54: 231–236, 1996
    OpenUrlCrossRefPubMed
  36. ↵
    1. Wolf PA,
    2. Abbott RD,
    3. Kannel WB
    : Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 22: 983–988, 1991
    OpenUrlAbstract/FREE Full Text
  37. ↵
    1. Benjamin EJ,
    2. Levy D,
    3. Vaziri SM,
    4. D'Agostino RB,
    5. Belanger AJ,
    6. Wolf PA
    : Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 271: 840–844, 1994
    OpenUrlCrossRefPubMed
  38. ↵
    1. Wolf PA,
    2. Benjamin EJ,
    3. Belanger AJ,
    4. Kannel WB,
    5. Levy D,
    6. D'Agostino RB
    : Secular trends in the prevalence of atrial fibrillation: The Framingham Study. Am Heart J 131: 790–795, 1996
    OpenUrlCrossRefPubMed
  39. ↵
    1. Furberg CD,
    2. Psaty BM,
    3. Manolio TA,
    4. Gardin JM,
    5. Smith VE,
    6. Rautaharju PM
    : Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol 74: 236–241, 1994
    OpenUrlCrossRefPubMed
  40. ↵
    1. Ruo B,
    2. Capra AM,
    3. Jensvold NG,
    4. Go AS
    : Racial variation in the prevalence of atrial fibrillation among patients with heart failure: The Epidemiology, Practice, Outcomes, and Costs of Heart Failure (EPOCH) study. J Am Coll Cardiol 43: 429–435, 2004
    OpenUrlCrossRefPubMed
  41. ↵
    1. Upshaw CB Jr.
    : Reduced prevalence of atrial fibrillation in black patients compared with white patients attending an urban hospital: an electrocardiographic study. J Natl Med Assoc 94: 204–208, 2002
    OpenUrlPubMed
  42. ↵
    1. Healey JS,
    2. Baranchuk A,
    3. Crystal E,
    4. Morillo CA,
    5. Garfinkle M,
    6. Yusuf S,
    7. Connolly SJ
    : Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: A meta-analysis. J Am Coll Cardiol 45: 1832–1839, 2005
    OpenUrlCrossRefPubMed
  43. ↵
    Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 325: 293–302, 1991
    OpenUrlCrossRefPubMed
  44. ↵
    1. Vaziri SM,
    2. Larson MG,
    3. Benjamin EJ,
    4. Levy D
    : Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 89: 724–730, 1994
    OpenUrlAbstract/FREE Full Text
  45. ↵
    1. Sarnak MJ,
    2. Poindexter A,
    3. Wang SR,
    4. Beck GJ,
    5. Kusek JW,
    6. Marcovina SM,
    7. Greene T,
    8. Levey AS
    : Serum C-reactive protein and leptin as predictors of kidney disease progression in the Modification of Diet in Renal Disease Study. Kidney Int 62: 2208–2215, 2002
    OpenUrlCrossRefPubMed
  46. ↵
    1. Oberg BP,
    2. McMenamin E,
    3. Lucas FL,
    4. McMonagle E,
    5. Morrow J,
    6. Ikizler TA,
    7. Himmelfarb J
    : Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 65: 1009–1016, 2004
    OpenUrlCrossRefPubMed
  47. ↵
    1. Hjalmarson A,
    2. Goldstein S,
    3. Fagerberg B,
    4. Wedel H,
    5. Waagstein F,
    6. Kjekshus J,
    7. Wikstrand J,
    8. El Allaf D,
    9. Vitovec J,
    10. Aldershvile J,
    11. Halinen M,
    12. Dietz R,
    13. Neuhaus KL,
    14. Janosi A,
    15. Thorgeirsson G,
    16. Dunselman PH,
    17. Gullestad L,
    18. Kuch J,
    19. Herlitz J,
    20. Rickenbacher P,
    21. Ball S,
    22. Gottlieb S,
    23. Deedwania P
    : Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: The Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). MERIT-HF Study Group. JAMA 283: 1295–1302, 2000
    OpenUrlCrossRefPubMed
  48. ↵
    1. Waagstein F,
    2. Bristow MR,
    3. Swedberg K,
    4. Camerini F,
    5. Fowler MB,
    6. Silver MA,
    7. Gilbert EM,
    8. Johnson MR,
    9. Goss FG,
    10. Hjalmarson A
    : Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet 342: 1441–1446, 1993
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology
Vol. 5, Issue 2
1 Feb 2010
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
Prevalence of Atrial Fibrillation and Its Predictors in Nondialysis Patients with Chronic Kidney Disease
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Prevalence of Atrial Fibrillation and Its Predictors in Nondialysis Patients with Chronic Kidney Disease
Wanwarat Ananthapanyasut, Sirikarn Napan, Earl H. Rudolph, Tasma Harindhanavudhi, Husam Ayash, Kelly E. Guglielmi, Edgar V. Lerma
CJASN Feb 2010, 5 (2) 173-181; DOI: 10.2215/CJN.03170509

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Prevalence of Atrial Fibrillation and Its Predictors in Nondialysis Patients with Chronic Kidney Disease
Wanwarat Ananthapanyasut, Sirikarn Napan, Earl H. Rudolph, Tasma Harindhanavudhi, Husam Ayash, Kelly E. Guglielmi, Edgar V. Lerma
CJASN Feb 2010, 5 (2) 173-181; DOI: 10.2215/CJN.03170509
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Disclosures
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

Original Articles

  • Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States
  • Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide
  • Zolpidem Versus Trazodone Initiation and the Risk of Fall-Related Fractures among Individuals Receiving Maintenance Hemodialysis
Show more Original Articles

Chronic Kidney Disease

  • NAT8 Variants, N-Acetylated Amino Acids, and Progression of CKD
  • Effect of Urate-Lowering Therapy on Cardiovascular and Kidney Outcomes
  • Combination Treatment with Sodium Nitrite and Isoquercetin on Endothelial Dysfunction among Patients with CKD
Show more Chronic Kidney Disease

Cited By...

  • Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation: JACC Review Topic of the Week
  • Blood Pressure and Incident Atrial Fibrillation in Older Patients Initiating Hemodialysis
  • Cardiovascular Events after New-Onset Atrial Fibrillation in Adults with CKD: Results from the Chronic Renal Insufficiency Cohort (CRIC) Study
  • Incident Atrial Fibrillation and the Risk of Stroke in Adults with Chronic Kidney Disease: The Stockholm CREAtinine Measurements (SCREAM) Project
  • The Impact of Atrial Fibrillation Clinical Subtype on Mortality
  • eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study
  • Redox and Activation of Protein Kinase A Dysregulates Calcium Homeostasis in Pulmonary Vein Cardiomyocytes of Chronic Kidney Disease
  • Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Pro
  • Changes in Renal Function in Patients With Atrial Fibrillation: An Analysis From the RE-LY Trial
  • Incident Atrial Fibrillation and Risk of Death in Adults With Chronic Kidney Disease
  • Efficacy and Safety of Dabigatran Compared With Warfarin in Relation to Baseline Renal Function in Patients With Atrial Fibrillation: A RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) Trial Analysis
  • Preventing Stroke in Patients With Chronic Kidney Disease and Atrial Fibrillation: Benefit and Risks of Old and New Oral Anticoagulants
  • Incident Atrial Fibrillation and Risk of End-Stage Renal Disease in Adults With Chronic Kidney Disease
  • Impact of Chronic Kidney Disease on Risk of Incident Atrial Fibrillation and Subsequent Survival in Medicare Patients
  • Renal Function After Catheter Ablation of Atrial Fibrillation
  • Google Scholar

Similar Articles

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe

© 2021 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire