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Comparison of incidence of acute kidney injury, chronic kidney disease and end-stage renal disease between atrial fibrillation and atrial flutter: real-world evidences from a propensity score-matched national cohort analysis

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Abstract

We investigated the adverse renal outcomes in patients affected by either atrial fibrillation (Afib) or atrial flutter (AFL). Using the Taiwan National Health Insurance research database, both cohorts were 1:1 propensity score matched based on age, sex, index year, and comorbidity using logistic regression model. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD) between the two cohorts were obtained using Cox proportional hazard regression models. Competing-risks regression models were applied to calculate the subhazard ratios (SHRs) and corresponding 95% CIs of the adverse renal outcomes. Afib patients were 1.15 and 1.33 times more likely to experience CKD and ESRD, respectively, than AFL patients (incidence rate per 10,000 person-years (IR): CKD, 10.8 vs 9.41; ESRD, 4.44 vs 3.34), with the adjusted HRs of 1.18 and 1.32 (CKD, 95% CI = 1.07–1.30; ESRD, 95% CI = 1.12–1.55). Afib patients were 1.08 times (95% CI = 1.01–1.16) more likely to have AKI than AFL patients after adjusting for confounding covariates. Competing risk analysis showed that Afib patients were 1.08 (95% CI = 1.01–1.15), 1.18 (95% CI = 1.07–1.30) and 1.32 (95% CI = 1.12–1.55) times more likely to experience AKI, CKD and ESRD than AFL subjects. This study showed that Afib conferred worse renal events of AKI, CKD and ESRD than AFL.

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Acknowledgements

This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212-123004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

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  1. School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan

    Wei-Syun Hu

  2. Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan

    Wei-Syun Hu

  3. Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan

    Cheng-Li Lin

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Correspondence to Wei-Syun Hu.

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Hu, WS., Lin, CL. Comparison of incidence of acute kidney injury, chronic kidney disease and end-stage renal disease between atrial fibrillation and atrial flutter: real-world evidences from a propensity score-matched national cohort analysis. Intern Emerg Med 14, 1113–1118 (2019). https://doi.org/10.1007/s11739-019-02089-1

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