Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function
Background
Early evidence suggests proteinuria is independently associated with incident atrial fibrillation (AF). We sought to investigate whether theassociation of proteinuria with incident AF is altered by kidney function.
背景：早期研究表明蛋白尿與發生房顫獨立相關。我們將探討腎功能的改變是否會影響這種關係。
Measurements and Main Results
Retrospectivecohort study using administrative healthcare databases in Ontario, Canada(2002–2015). A total of 736 666 patients aged ≥40 years not receiving dialysis and with no previoushistory of AF were included. Proteinuria was defined using the urine albumin-to-creatinine ratio (ACR) andkidney function by the estimated glomerular filtration rate (eGFR). The primary outcome was time to AF.Cox proportional models were used to determine the hazard ratio for AF censoredfor death, dialysis, kidney transplant, or end of follow-up. Fine and Greymodels were used to determine thesubdistribution hazard ratiofor AF,with death as a competing event. Median follow-up was 6 years and 44 809patients developed AF. In adjusted models, ACR and eGFR were associated with AF(P<0.0001).The association of proteinuria with AF differed basedon kidney function (ACR 9 eGFR interaction, P<0.0001). Overt proteinuria(ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact (eGFR,120) versus reduced (eGFR, 30) kidney function(adjusted hazard ratios,4.5 [95% CI, 4.0–5.1] and 2.6 [95% CI, 2.4–2.8],respectively;referent ACR 0 and eGFR 120). Results were similar in competing risk analyses.
方法及結果：對加拿大安大略2002年至2015年的醫療數據庫進行回顧性隊列研究。共有736666名大於40歲患者納入，其沒有接受透析或房顫病史。蛋白尿通過ACR定義，腎功能通過eGFR評估。主要結果為發生房顫的時間。中位隨訪時間為6年，44809名患者發生房顫。在校正模型中，ACR及eGFR與房顫相關(P<0.0001)。腎功能不同時，蛋白尿與房顫發生的關係則不同。腎功能正常患者(ACR, 120mg/mmol)相比於腎功能受損患者(eGFR,30)，其顯著蛋白尿(ACR, 120mg/mmol)與房顫發生相關性更大(校正風險比值分別為4.5 [95%CI, 4.0–5.1]和2.6 [95%CI, 2.4–2.8])。
Conclusion
Proteinuriaincreases the risk of incident AF markedly in patients with intact kidneyfunction compared with those with decreased kidney function. Screening andpreventative strategies should consider proteinuria as an independent riskfactor for AF.
結論：相比於腎功能不全的患者，正常腎功能患者蛋白尿增加顯著增加房顫發生的風險。應將蛋白尿視為房顫的獨立危險因素。
翻譯：張楠
審校：曹廣慧
