Correlation between Atrial Fibrillation and the Risk of New-onset Chronic Kidney Disease in Northern Chinese Population

doi:10.12114/j.issn.1007-9572.2023.0006

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (36): 4521-4526.DOI: 10.12114/j.issn.1007-9572.2023.0006

Special Issue: 泌尿系统疾病最新文章合辑；心房颤动最新文章合辑；肾脏疾病最新文章合辑

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Correlation between Atrial Fibrillation and the Risk of New-onset Chronic Kidney Disease in Northern Chinese Population

1. Third Department of Urology, Tangshan Workers' Hospital, Tangshan 063000, China
2. Department of Cardiology, Tangshan Workers' Hospital, Tangshan 063000, China
3. Department of RehabilitationMedicine, Tangjiazhuang Hospital of Kailuan (Group) Co., Ltd, Tangshan 063000, China
4. Cardiac Cathlab of Tangshan Workers' Hospital, Tangshan 063000, China
5. Department of Cardiology, Kailuan Hospital, Tangshan 063000, China
6. School of Clinical Medicine, North China University of Science and Technology, Tangshan 063000, China

Received:2022-12-05 Revised:2023-02-16 Published:2023-12-20 Online:2023-04-28
Contact: HAN Quanle

中国北方人群心房颤动与新发慢性肾脏病发病风险的相关性研究

1．063000　河北省唐山市工人医院泌尿外三科
2．063000　河北省唐山市工人医院心内科
3．063000　河北省唐山市开滦（集团）有限责任公司唐家庄医院康复医学科
4．063000　河北省唐山市工人医院导管室
5．063000　河北省唐山市开滦总医院心内科
6．063000　河北省唐山市，华北理工大学临床医学院

通讯作者: 韩全乐
作者简介:
作者贡献：张爱丽、韩全乐提出研究思路，设计方案；侯旗旗、张伯亨、吴寿岭负责相关论文检索；张伯亨、张佳伟、曹宏霞、张超负责数据的收集、核查；侯旗旗、陈朔华、李康博负责数据的整理和统计分析；张爱丽负责论文起草；韩全乐负责文章的质量控制及审校，对论文整体负责。
基金资助:
河北省医学重点科技研究计划(20221777)

Abstract

Abstract:

Background

The global population disease burden report shows that atrial fibrillation (AF) and chronic kidney disease (CKD) have emerged as the fast-growing causes of death in the last 20 years. The concept of cardiorenal syndrome suggests that AF may increase the risk of new-onset CKD, however, there are few studies related to the increased risk of new-onset CKD with AF at home and abroad, and the interaction with age remains unclear atpresent.

Objective

To investigate whether AF increases the risk of new-onset CKD in northern Chinese population.

Methods

The population who attended a comprehensive health check-up for the employees of Kailuan Group in Hebei Province from 2006 to 2010 were selected as study subjects. The general information and laboratory test results of the study subjects were collected, and the study subjects were followed up with the final follow-up date of 2020-12-31 and the end point of new-onset CKD. The included patients were divided into AF group (n=368) and non-AF group (n=110 487) according to the presence or absence of AF. The cumulative incidence of new-onset CKD in patients was calculated using the lifetable method. The Kaplan-Meier method was used to plot the survival curves of the cumulative incidence of new-onset CKD in the AF group and the non-AF group. The Log-rank test was used to compare the differences in the cumulative incidence of CKD between the two groups. The multivariate Cox proportional hazard regression model was used to explore the effect of AF on the risk of new-onset CKD.

Results

AF group was higher than non-AF group in age, male proportion, systolic blood pressure level, diastolic blood pressure level, body mass index, the proportions of education level, participation in physical exercise, hypertension, diabetes, taking hypotensive drugs and hypoglycemic drugs, and high-sensitivity C-reactive protein level (P<0.05) . AF group was lower than non-AF group in the proportion of alcohol consumption, total cholesterol, triacylglycerol and low density lipoprotein cholesterinlevels (P<0.05) . There were statistically significant differences in the incidence and cumulative incidence of new-onset CKD between atrial fibrillation group and non-atrial fibrillation group (P<0.05) . Stratifying the study population by age, there were statistically significant differences in the incidence and cumulative incidence of new-onset CKD in the study subjects aged≤65 years (P<0.05) and statistically significant difference in the incidence of new-onset CKD in the study subjects aged>65 years (P<0.05) . The results of the adjusted multivariate Cox proportional hazard regression analysis showed that AF was a risk factor for new-onset CKD in people aged≤65 years〔HR=1.350, 95%CI (1.038, 1.755) , P=0.025〕.

Conclusion

AF is an independent risk factor for new-onset CKD in northern Chinese population, especially for young and middle-aged populationaged≤65 years.

Key words: Atrial fibrillation, Renal insufficiency, chronic, Incidence, Cohort studies, Risk factors, Correlation study

摘要： 背景全球人群疾病负担报告显示，心房颤动与慢性肾脏病（CKD）成了近20年增长较快的死亡原因。心肾综合征的概念指出心房颤动可能增加新发CKD的发病风险，但目前国内外对心房颤动增加新发CKD发病风险的相关研究较少，并且与年龄的交互作用尚不明确。目的探讨中国北方人群心房颤动是否增加CKD发病风险。方法选取2006—2010年河北省开滦集团职工健康查体人群为研究对象，收集研究对象的一般资料和实验室检查结果，并对研究对象进行随访，末次随访时间2020-12-31，观察终点事件为新发CKD。根据是否患有心房颤动将患者分为非心房颤动组（n=110 487）和心房颤动组（n=368）。用寿命表法计算患者新发CKD的累积发病率，采用Kaplan-Meier法绘制心房颤动组与非心房颤动组新发CKD累积发病率的生存曲线，并用Log-rank检验比较两组患者累积CKD发生率的差异。采用多因素Cox比例风险回归模型分析探究心房颤动对新发CKD发病风险的影响。结果心房颤动组患者年龄、男性比例、收缩压、舒张压、BMI、受教育程度、参加体育锻炼、高血压、糖尿病、服用降压药、服用降糖药比例、超敏C反应蛋白高于非心房颤动组，饮酒比例、总胆固醇、三酰甘油、低密度脂蛋白胆固醇低于非心房颤动组（P<0.05）。心房颤动组与非心房颤动组新发CKD的发生率和累积发病率比较，差异有统计学意义（P<0.05）。将研究对象按年龄进行分层，≤65岁研究对象心房颤动组与非心房颤动组新发CKD的发生率和累积发病率比较，差异有统计学意义（P<0.05）；>65岁研究对象心房颤动组与非心房颤动组新发CKD的发生率比较，差异有统计学意义（P<0.05）。经校正后的多因素Cox比例风险回归模型分析结果显示，≤65岁人群心房颤动是新发CKD的危险因素〔HR=1.350，95%CI（1.038，1.755），P=0.025〕。结论心房颤动是中国北方人群新发CKD发病的独立危险因素，特别是对于年龄≤65岁的中青年人群。

关键词: 心房颤动, 肾功能不全, 慢性, 发病率, 队列研究, 危险因素, 相关性研究

ZHANG Aili,HOU Qiqi,HAN Quanle, et al. Correlation between Atrial Fibrillation and the Risk of New-onset Chronic Kidney Disease in Northern Chinese Population[J]. Chinese General Practice, 2023, 26(36): 4521-4526. DOI: 10.12114/j.issn.1007-9572.2023.0006.
张爱丽,侯旗旗,韩全乐等. 中国北方人群心房颤动与新发慢性肾脏病发病风险的相关性研究[J]. 中国全科医学, 2023, 26(36): 4521-4526. DOI: 10.12114/j.issn.1007-9572.2023.0006.

Figures/Tables 9

References 31

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性别	Scr（μmol/L）	eGFR〔mL·min^-1·（1.73 m²）^-1〕
女性	≤62	144×（Scr/62）-0.329×（0.993）年龄
	>62	144×（Scr/62）-1.209×（0.993）年龄
男性	≤80	141×（Scr/80）-0.411×（0.993）年龄
	>80	141×（Scr/80）-1.209×（0.993）年龄

性别	Scr（μmol/L）	eGFR〔mL·min^-1·（1.73 m²）^-1〕
女性	≤62	144×（Scr/62）-0.329×（0.993）年龄
	>62	144×（Scr/62）-1.209×（0.993）年龄
男性	≤80	141×（Scr/80）-0.411×（0.993）年龄
	>80	141×（Scr/80）-1.209×（0.993）年龄

组别	人数	年龄（岁）	性别（男/女）	SBP （mmHg）	DBP （mmHg）	BMI （kg/m²）	受教育程度〔名（%）〕		吸烟〔名（%）〕	饮酒〔名（%）〕	参加体育锻炼〔名（%）〕
组别	人数	年龄（岁）	性别（男/女）	SBP （mmHg）	DBP （mmHg）	BMI （kg/m²）	高中以下	高中及以上	吸烟〔名（%）〕	饮酒〔名（%）〕	参加体育锻炼〔名（%）〕
非心房颤动组	110 487	49.0±12.9	88 288/22 199	128±20	83±12	24.8±3.5	82 092（74.30）	28 395（25.70）	40 768（36.90）	44 130（39.94）	95 865（86.77）
心房颤动组	368	63.4±10.6	338/30	135±21	85±12	25.3±3.7	311（84.51）	57（15.49）	123（33.42）	124（33.70）	342（92.93）
统计检验量值		455.65^a	32.61	37.21^a	14.23^a	7.13^a	20.03		1.90	5.96	12.17
P值		<0.001	<0.001	<0.001	<0.001	0.007	<0.001		0.168	0.015	0.001
组别	高血压〔名（%）〕	糖尿病〔名（%）〕	服用降压药〔名（%）〕	服用降糖药〔名（%）〕	服用降脂药〔名（%）〕	TC （mmol/L）	TG〔M（P₂₅，P₇₅），mmol/L〕	LDL-C （mmol/L）	HDL-C （mmol/L）	FPG （mmol/L）	hs-CRP〔M（P₂₅，P₇₅），mmol/L〕
非心房颤动组	42 946（38.87）	8 562（7.75）	9 123（8.26）	2 027（1.83）	645（0.58）	4.92±1.05	1.24（0.86，1.89）	2.38±0.89	1.51±0.39	5.42±1.48	0.97（0.38，2.65）
心房颤动组	200（54.35）	40（10.87）	62（16.85）	12（3.26）	5（1.36）	4.70±1.10	1.13（0.83，1.61）	2.21±1.05	1.52±0.39	5.41±1.37	1.70（0.60，4.37）
检验统计量值	36.97	4.99	35.61	4.13	3.78	15.98^a	14.68^b	13.80^a	0.07^a	0.01^a	35.85^b
P值	<0.001	0.026	<0.001	0.042	0.052	<0.001	<0.001	<0.001	0.789	0.923	<0.001

组别	人数	年龄（岁）	性别（男/女）	SBP （mmHg）	DBP （mmHg）	BMI （kg/m²）	受教育程度〔名（%）〕		吸烟〔名（%）〕	饮酒〔名（%）〕	参加体育锻炼〔名（%）〕
组别	人数	年龄（岁）	性别（男/女）	SBP （mmHg）	DBP （mmHg）	BMI （kg/m²）	高中以下	高中及以上	吸烟〔名（%）〕	饮酒〔名（%）〕	参加体育锻炼〔名（%）〕
非心房颤动组	110 487	49.0±12.9	88 288/22 199	128±20	83±12	24.8±3.5	82 092（74.30）	28 395（25.70）	40 768（36.90）	44 130（39.94）	95 865（86.77）
心房颤动组	368	63.4±10.6	338/30	135±21	85±12	25.3±3.7	311（84.51）	57（15.49）	123（33.42）	124（33.70）	342（92.93）
统计检验量值		455.65^a	32.61	37.21^a	14.23^a	7.13^a	20.03		1.90	5.96	12.17
P值		<0.001	<0.001	<0.001	<0.001	0.007	<0.001		0.168	0.015	0.001
组别	高血压〔名（%）〕	糖尿病〔名（%）〕	服用降压药〔名（%）〕	服用降糖药〔名（%）〕	服用降脂药〔名（%）〕	TC （mmol/L）	TG〔M（P₂₅，P₇₅），mmol/L〕	LDL-C （mmol/L）	HDL-C （mmol/L）	FPG （mmol/L）	hs-CRP〔M（P₂₅，P₇₅），mmol/L〕
非心房颤动组	42 946（38.87）	8 562（7.75）	9 123（8.26）	2 027（1.83）	645（0.58）	4.92±1.05	1.24（0.86，1.89）	2.38±0.89	1.51±0.39	5.42±1.48	0.97（0.38，2.65）
心房颤动组	200（54.35）	40（10.87）	62（16.85）	12（3.26）	5（1.36）	4.70±1.10	1.13（0.83，1.61）	2.21±1.05	1.52±0.39	5.41±1.37	1.70（0.60，4.37）
检验统计量值	36.97	4.99	35.61	4.13	3.78	15.98^a	14.68^b	13.80^a	0.07^a	0.01^a	35.85^b
P值	<0.001	0.026	<0.001	0.042	0.052	<0.001	<0.001	<0.001	0.789	0.923	<0.001

组别	人数	新发CKD〔例（%）〕	累积发病率（%）
非心房颤动组	110 487	22 725（20.57）	21.77
心房颤动组	368	95（25.82）	30.40
χ²值		6.18^a	14.30^b
P值		0.003	<0.001

Correlation between Atrial Fibrillation and the Risk of New-onset Chronic Kidney Disease in Northern Chinese Population

中国北方人群心房颤动与新发慢性肾脏病发病风险的相关性研究

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组别	人数	新发CKD〔例（%）〕	累积发病率（%）
非心房颤动组	99 023	19 598（19.79）	20.79
心房颤动组	199	56（28.14）	30.48
χ²值		8.72^a	11.41^b
P值		0.001	0.001

组别	人数	新发CKD〔例（%）〕	累积发病率（%）
非心房颤动组	11 464	3 127（27.28）	31.32
心房颤动组	169	39（23.08）	30.08
χ²值		1.48^a	0.04^b
P值		0.034	0.848

变量	模型一		模型二		模型三
变量	HR（95%CI）	P值	HR（95% CI）	P值	HR（95% CI）	P值
全人群
非心房颤动	1.000		1.000		1.000
心房颤动	1.477（1.208，1.806）	<0.001	1.167（0.954，1.428）	0.133	1.175（0.960，1.438）	0.118
≤65岁人群
非心房颤动	1.000		1.000		1.000
心房颤动	1.566（1.204，2.035）	0.001	1.363（1.048，1.769）	0.021	1.350（1.038，1.755）	0.025
>65岁人群
非心房颤动	1.000		1.000		1.000
心房颤动	0.970（0.707，1.330）	0.855	1.007（0.734，1.381）	0.968	0.999（0.728，1.371）	0.996

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