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Abstract：
UNASSIGNED: The association between the longitudinal patterns of estimated glomerular filtration rate (eGFR) and risk of atrial fibrillation (AF) in populations with normal or mildly impaired renal function is not well characterized. We sought to explore the eGFR trajectories in populations with normal or mildly impaired renal function and their association with AF.
UNASSIGNED: This prospective cohort study included 62,407 participants who were free of AF, cardiovascular diseases, and moderate to severe renal insufficiency (eGFR <60 mL/min/1.73 m2) before 2010. The eGFR trajectories were developed using latent mixture modeling based on examination data in 2006, 2008, and 2010. Incident AF cases were identified in biennial electrocardiogram assessment and a review of medical insurance data and discharge registers. We used Cox regression models to estimate the hazard ratios and 95% confidence intervals (CIs) for incident AF.
UNASSIGNED: According to survey results for the range and changing pattern of eGFR during 2006-2010, four trajectories were identified: high-stable (range, 107.47-110.25 mL/min/1.73 m2; n = 11,719), moderate-increasing (median increase from 83.83 to 100.37 mL/min/1.73 m2; n = 22,634), high-decreasing (median decrease from 101.72 to 89.10 mL/min/1.73 m2; n = 7,943), and low-stable (range, 73.48-76.78 mL/min/1.73 m2; n = 20,111). After an average follow-up of 9.63 years, a total of 485 cases of AF were identified. Compared with the high-stable trajectory, the adjusted hazard ratios of AF were 1.70 (95% CI, 1.09-2.66) for the moderate-increasing trajectory, 1.92 (95% CI, 1.18-3.13) for the high-decreasing trajectory, and 2.28 (95% CI, 1.46-3.56) for the low-stable trajectory. The results remained consistent across a number of sensitivity analyses.
UNASSIGNED: The trajectories of eGFR were associated with subsequent AF risk in populations with normal or mildly impaired renal function.
The relation between estimated glomerular filtration rate (eGFR) within the normal or mildly impaired range and risk of atrial fibrillation (AF) in former studies is controversial, and data on longitudinal pattern of eGFR in such topic is sparse. In this cohort study, we identified 4 trajectories of eGFR in populations with normal or mildly impaired renal function. Relative to populations with high-stable pattern of eGFR, those with low-stable pattern, high-decreasing pattern and moderate-increasing pattern were associated with 128%, 92%, and 70% higher risk of AF, respectively. These findings suggested that monitoring eGFR trajectories is an important approach for AF prediction in populations with normal or mildly impaired renal function. Decreasing and consistently low eGFR trajectories within the currently designated normal or mildly impaired range may still significantly increase the risk of AF.
UNASSIGNED: This prospective cohort study included 62,407 participants who were free of AF, cardiovascular diseases, and moderate to severe renal insufficiency (eGFR <60 mL/min/1.73 m2) before 2010. The eGFR trajectories were developed using latent mixture modeling based on examination data in 2006, 2008, and 2010. Incident AF cases were identified in biennial electrocardiogram assessment and a review of medical insurance data and discharge registers. We used Cox regression models to estimate the hazard ratios and 95% confidence intervals (CIs) for incident AF.
UNASSIGNED: According to survey results for the range and changing pattern of eGFR during 2006-2010, four trajectories were identified: high-stable (range, 107.47-110.25 mL/min/1.73 m2; n = 11,719), moderate-increasing (median increase from 83.83 to 100.37 mL/min/1.73 m2; n = 22,634), high-decreasing (median decrease from 101.72 to 89.10 mL/min/1.73 m2; n = 7,943), and low-stable (range, 73.48-76.78 mL/min/1.73 m2; n = 20,111). After an average follow-up of 9.63 years, a total of 485 cases of AF were identified. Compared with the high-stable trajectory, the adjusted hazard ratios of AF were 1.70 (95% CI, 1.09-2.66) for the moderate-increasing trajectory, 1.92 (95% CI, 1.18-3.13) for the high-decreasing trajectory, and 2.28 (95% CI, 1.46-3.56) for the low-stable trajectory. The results remained consistent across a number of sensitivity analyses.
UNASSIGNED: The trajectories of eGFR were associated with subsequent AF risk in populations with normal or mildly impaired renal function.
The relation between estimated glomerular filtration rate (eGFR) within the normal or mildly impaired range and risk of atrial fibrillation (AF) in former studies is controversial, and data on longitudinal pattern of eGFR in such topic is sparse. In this cohort study, we identified 4 trajectories of eGFR in populations with normal or mildly impaired renal function. Relative to populations with high-stable pattern of eGFR, those with low-stable pattern, high-decreasing pattern and moderate-increasing pattern were associated with 128%, 92%, and 70% higher risk of AF, respectively. These findings suggested that monitoring eGFR trajectories is an important approach for AF prediction in populations with normal or mildly impaired renal function. Decreasing and consistently low eGFR trajectories within the currently designated normal or mildly impaired range may still significantly increase the risk of AF.
摘要：
■在肾功能正常或轻度受损的人群中，估计的肾小球滤过率（eGFR）的纵向模式与房颤（AF）风险之间的关联尚未得到很好的表征。我们试图探索肾功能正常或轻度受损人群的eGFR轨迹及其与AF的关系。
■这项前瞻性队列研究包括62,407名没有房颤的参与者，心血管疾病,和中度至重度肾功能不全（eGFR<60mL/min/1.73m2）在2010年之前。使用基于2006年、2008年和2010年的检查数据的潜在混合建模来开发eGFR轨迹。在两年一次的心电图评估以及对医疗保险数据和出院记录的审查中确定了房颤事件。我们使用Cox回归模型来估计发生AF的风险比和95％置信区间（CI）。
■根据对eGFR在2006-2010年期间的范围和变化规律的调查结果，确定了四个轨迹：高稳定（范围，107.47-110.25毫升/分钟/1.73平方米；n=11,719），中度增加（中位数从83.83增加到100.37mL/min/1.73m2；n=22,634），高下降（中位数从101.72下降到89.10mL/min/1.73m2；n=7,943），和低稳定(范围，73.48-76.78mL/min/1.73m2；n=20,111）。平均随访9.63年,共发现485例房颤.与高稳定轨迹相比，调整后的房颤风险比为1.70(95%CI,1.09-2.66),高递减轨迹为1.92(95%CI，1.18-3.13)，低稳定轨迹为2.28（95%CI，1.46-3.56）。在许多敏感性分析中，结果保持一致。
■在肾功能正常或轻度受损的人群中，eGFR的轨迹与随后的房颤风险相关。
在以前的研究中，在正常或轻度受损范围内估计的肾小球滤过率（eGFR）与房颤（AF）风险之间的关系存在争议，在这样的主题中，关于eGFR纵向模式的数据是稀疏的。在这项队列研究中，我们在肾功能正常或轻度受损的人群中确定了eGFR的4个轨迹.相对于eGFR高稳定模式的人群，那些具有低稳定模式的人，高下降模式和中等上升模式与128%相关，92%,房颤的风险高70%,分别。这些发现表明，监测eGFR轨迹是预测肾功能正常或轻度受损人群房颤的重要方法。在当前指定的正常或轻度受损范围内，eGFR轨迹的减少和持续低仍可能显着增加AF的风险。
■这项前瞻性队列研究包括62,407名没有房颤的参与者，心血管疾病,和中度至重度肾功能不全（eGFR<60mL/min/1.73m2）在2010年之前。使用基于2006年、2008年和2010年的检查数据的潜在混合建模来开发eGFR轨迹。在两年一次的心电图评估以及对医疗保险数据和出院记录的审查中确定了房颤事件。我们使用Cox回归模型来估计发生AF的风险比和95％置信区间（CI）。
■根据对eGFR在2006-2010年期间的范围和变化规律的调查结果，确定了四个轨迹：高稳定（范围，107.47-110.25毫升/分钟/1.73平方米；n=11,719），中度增加（中位数从83.83增加到100.37mL/min/1.73m2；n=22,634），高下降（中位数从101.72下降到89.10mL/min/1.73m2；n=7,943），和低稳定(范围，73.48-76.78mL/min/1.73m2；n=20,111）。平均随访9.63年,共发现485例房颤.与高稳定轨迹相比，调整后的房颤风险比为1.70(95%CI,1.09-2.66),高递减轨迹为1.92(95%CI，1.18-3.13)，低稳定轨迹为2.28（95%CI，1.46-3.56）。在许多敏感性分析中，结果保持一致。
■在肾功能正常或轻度受损的人群中，eGFR的轨迹与随后的房颤风险相关。
在以前的研究中，在正常或轻度受损范围内估计的肾小球滤过率（eGFR）与房颤（AF）风险之间的关系存在争议，在这样的主题中，关于eGFR纵向模式的数据是稀疏的。在这项队列研究中，我们在肾功能正常或轻度受损的人群中确定了eGFR的4个轨迹.相对于eGFR高稳定模式的人群，那些具有低稳定模式的人，高下降模式和中等上升模式与128%相关，92%,房颤的风险高70%,分别。这些发现表明，监测eGFR轨迹是预测肾功能正常或轻度受损人群房颤的重要方法。在当前指定的正常或轻度受损范围内，eGFR轨迹的减少和持续低仍可能显着增加AF的风险。
