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      Elevated Troponin T and Enlarged Left Atrium Are Associated with the Incidence of Atrial Fibrillation in Patients with CKD Stage 4–5


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          Introduction: Atrial fibrillation (AF) and CKD are commonly coexisting conditions. However, data on epidemiology of AF in patients with CKD stage 4–5 is scarce. Methods: We prospectively enrolled 210 consecutive non-dialysis patients with CKD stage 4–5 between 2013 and 2017. Follow-up data on AF incidence along with medical history, laboratory tests, and echocardiography at baseline were gathered. Results: At baseline, mean age was 62 years, estimated glomerular filtration rate 12.8 mL/min, and 73/210 (34.8%) participants were female. Altogether, 41/210 (19.5%) patients had a previous diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF occurred in 33/169 (19.5%) patients (69.9 events/1,000 person-years). In the Cox proportional hazard model, age >60 years (HR 4.27, CI 95% 1.57–11.64, p < 0.01), elevated troponin T (TnT) >50 ng/L (HR 3.61, CI 95% 1.55–8.37, p < 0.01), and left atrial volume index (LAVI) >30 mL/m<sup>2</sup> (HR 4.82, CI 95% 1.11–21.00, p = 0.04) were independently associated with the incidence of new-onset AF. Conclusion: The prevalence and incidence of AF was markedly high in this prospective study on patients with CKD stage 4–5. Elevated TnT and increased LAVI were independently associated with the occurrence of new-onset AF in patients with severe CKD.

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          Most cited references17

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          Incident atrial fibrillation and risk of end-stage renal disease in adults with chronic kidney disease.

          Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD). However, the long-term impact of development of AF on the risk of adverse renal outcomes in patients with CKD is unknown. In this study, we determined the association between incident AF and risk of end-stage renal disease (ESRD) among adults with CKD.
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            Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients.

            Based on an analysis of claims-based data of 8.298 million members of two German statutory health insurance funds, the aim of this contribution is to quantify age-/gender-specific prevalence/incidence of atrial fibrillation (AF) in a German setting. Patients were classified as AF prevalent, if they had received at least two outpatient diagnoses of AF (ICD10-Code I48.1-) in two different quarters of the year and/or had received at least one main AF diagnosis during inpatient treatment between 1 January 2007 and 12 December 2008. They were considered to have had new onset AF in 2008 under the following conditions; first, there was no AF diagnosis in 2007; secondly, patients had not received oral anticoagulant medication in 2007; and thirdly, patients had received either one inpatient/two outpatient diagnoses of AF in 2008. In our sample, a total of 176 891 patients had AF. AF prevalence was 2.132%. The average age of these AF patients was 73.1 years, and 55.5% (98 190 patients) were male. The incidence of AF in our sample was 4.358 cases/1000 person-years in men and 3.868 cases/1000 person-years in women. A comparison of the distribution of AF prevalence/incidence in our population with that in already published studies showed that our figures were higher, especially in the age groups above 70 years. Our data show that in a large industrial nation such as Germany care provision structures are going to be challenged by a requirement to treat more AF patients in the future.
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              The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients.

              Atrial fibrillation (AF) is common in dialysis patients and is associated with increased morbidity and mortality. The pathophysiology may be related to common risk factors for both AF and renal disease or to dialysis-specific factors. The purpose of this study was to determine whether and how AF onset relates to the dialysis procedure itself.

                Author and article information

                S. Karger AG
                January 2021
                02 December 2020
                : 145
                : 1
                : 71-77
                [_a] aKidney Center, Turku University Hospital and University of Turku, Turku, Finland
                [_b] bDepartment of Clinical Physiology, Turku University Hospital and University of Turku, Turku, Finland
                [_c] cPaavo Nurmi Centre & Unit for Health and Physical Activity, University of Turku, Turku, Finland
                [_d] dHeart Center, Turku University Hospital and University of Turku, Turku, Finland
                [_e] eDepartment of Anaesthesiology and Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
                [_f] fPerioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, Turku, Finland
                Author notes
                *Markus Hakamäki, Kidney Center, Turku University Hospital, Hämeentie 11, PO Box 52, FI–20521 Turku (Finland), markus.hakamaki@tyks.fi
                Author information
                511451 Nephron 2021;145:71–77
                © 2020 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 19 July 2020
                : 08 September 2020
                Page count
                Figures: 3, Tables: 2, Pages: 7
                Clinical Practice: Research Article

                Cardiovascular Medicine,Nephrology
                Chronic kidney disease,Atrial fibrillation,Incidence,Troponin T,Left atrial volume index


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