Association of Estimated Glomerular Filtration Rate Trajectories with Atrial Fibrillation Risk in Populations with Normal or Mildly Impaired Renal Function

Introduction: 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. Methods: 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/1.73m2) 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 (CI) for incident AF. Results: According to survey results for the range and changing pattern of eGFR during 2006 to 2010, four trajectories were identified: high-stable (range, 107.47 to 110.25 mL/min/1.73m2; n=11,719), moderate-increasing (median increase from 83.83 to 100.37 mL/min/1.73m2; n=22,634), high-decreasing (median decrease from 101.72 to 89.10 mL/min/1.73m2; n=7,943), and low-stable (range, 73.48 to 76.78 mL/min/1.73m2; 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. Conclusions: The trajectories of eGFR were associated with subsequent AF risk in populations with normal or mildly impaired renal function.