{"title":"早搏心房复合体负担高,肾功能衰退风险大","authors":"Chao-Yu Chen, Chih-Hen Yu, Po-Tseng Lee, Mu-Shiang Huang, Pin-Hsuan Chiu, Pei-Fang Su, Ping-Yen Liu, Ting-Chun Huang","doi":"10.1093/ckj/sfae208","DOIUrl":null,"url":null,"abstract":"Background Atrial arrhythmia, particularly atrial fibrillation (AF), is known to be associated with renal function decline and increased risk of end-stage kidney disease. These years, premature atrial complexes (PACs) as subclinical arrhythmia are proposed to be a marker of atrial cardiomyopathy and associated with poor clinical outcomes. However, the relationship between excessive daily PAC burden and renal outcomes remains unexplored. Methods This retrospective, all-comers cohort study analyzed 30 488 consecutive Holter monitoring records obtained from a validated Holter databank at a referral medical center in Taiwan between 2011 and 2018. After exclusion, 10 981 patients were categorized into three groups: high daily PAC burden (≥100 beats per day), low PAC burden (<100 beats per day), and the AF group. We used parallel propensity score matching to balance confounding factors between groups. The primary study interest was major adverse kidney events, including an estimated glomerular filtration rate (eGFR) decline of 40%, eGFR below 15 mL/min/1.73m², or the initiation of hemodialysis. Results After a mean follow-up of 4.07 ± 3.03 years, patients with high PAC burden had a 1.24-fold higher incidence of major adverse kidney events compared to the low PAC burden group (95% CI: 1.03–1.50). The risk of major adverse kidney events was similar between patients with AF and those with high PAC burden (adjusted HR: 1.05, 95% CI: 0.87–1.25), but significantly higher in the AF group than in the low PAC burden group (adjusted HR: 1.29, 95% CI: 1.07–1.56). Conclusion Excessive daily PAC burden is associated with a higher risk of major adverse kidney events and has a comparable impact as AF.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High premature atrial complex burden and risk of renal function decline\",\"authors\":\"Chao-Yu Chen, Chih-Hen Yu, Po-Tseng Lee, Mu-Shiang Huang, Pin-Hsuan Chiu, Pei-Fang Su, Ping-Yen Liu, Ting-Chun Huang\",\"doi\":\"10.1093/ckj/sfae208\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background Atrial arrhythmia, particularly atrial fibrillation (AF), is known to be associated with renal function decline and increased risk of end-stage kidney disease. These years, premature atrial complexes (PACs) as subclinical arrhythmia are proposed to be a marker of atrial cardiomyopathy and associated with poor clinical outcomes. However, the relationship between excessive daily PAC burden and renal outcomes remains unexplored. Methods This retrospective, all-comers cohort study analyzed 30 488 consecutive Holter monitoring records obtained from a validated Holter databank at a referral medical center in Taiwan between 2011 and 2018. After exclusion, 10 981 patients were categorized into three groups: high daily PAC burden (≥100 beats per day), low PAC burden (<100 beats per day), and the AF group. We used parallel propensity score matching to balance confounding factors between groups. The primary study interest was major adverse kidney events, including an estimated glomerular filtration rate (eGFR) decline of 40%, eGFR below 15 mL/min/1.73m², or the initiation of hemodialysis. Results After a mean follow-up of 4.07 ± 3.03 years, patients with high PAC burden had a 1.24-fold higher incidence of major adverse kidney events compared to the low PAC burden group (95% CI: 1.03–1.50). The risk of major adverse kidney events was similar between patients with AF and those with high PAC burden (adjusted HR: 1.05, 95% CI: 0.87–1.25), but significantly higher in the AF group than in the low PAC burden group (adjusted HR: 1.29, 95% CI: 1.07–1.56). Conclusion Excessive daily PAC burden is associated with a higher risk of major adverse kidney events and has a comparable impact as AF.\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-07-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfae208\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfae208","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
High premature atrial complex burden and risk of renal function decline
Background Atrial arrhythmia, particularly atrial fibrillation (AF), is known to be associated with renal function decline and increased risk of end-stage kidney disease. These years, premature atrial complexes (PACs) as subclinical arrhythmia are proposed to be a marker of atrial cardiomyopathy and associated with poor clinical outcomes. However, the relationship between excessive daily PAC burden and renal outcomes remains unexplored. Methods This retrospective, all-comers cohort study analyzed 30 488 consecutive Holter monitoring records obtained from a validated Holter databank at a referral medical center in Taiwan between 2011 and 2018. After exclusion, 10 981 patients were categorized into three groups: high daily PAC burden (≥100 beats per day), low PAC burden (<100 beats per day), and the AF group. We used parallel propensity score matching to balance confounding factors between groups. The primary study interest was major adverse kidney events, including an estimated glomerular filtration rate (eGFR) decline of 40%, eGFR below 15 mL/min/1.73m², or the initiation of hemodialysis. Results After a mean follow-up of 4.07 ± 3.03 years, patients with high PAC burden had a 1.24-fold higher incidence of major adverse kidney events compared to the low PAC burden group (95% CI: 1.03–1.50). The risk of major adverse kidney events was similar between patients with AF and those with high PAC burden (adjusted HR: 1.05, 95% CI: 0.87–1.25), but significantly higher in the AF group than in the low PAC burden group (adjusted HR: 1.29, 95% CI: 1.07–1.56). Conclusion Excessive daily PAC burden is associated with a higher risk of major adverse kidney events and has a comparable impact as AF.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.