Multiethnic study shows no association between reduced kidney function, most arrhythmias
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Findings from a study of patients with and those without chronic kidney disease demonstrated “little evidence” of an association between reduced kidney function and six of seven arrythmia outcomes.
The exception to this was an observation that suggested the doubling of urinary albumin-creatinine ratio led to an increased likelihood of monitor-detected atrial fibrillation (AF)/flutter. Although the researchers noted this finding aligns with previous investigations evaluating kidney function and clinically recognized AF, they contended literature on arrhythmias other than AF is “sparse” in patients with CKD.
Extended ambulatory cardiac monitoring
“Arrhythmias are often asymptomatic and not detected clinically, thus the true incidence and prevalence among CKD patients are unknown. Extended ambulatory cardiac monitoring is a sensitive and unbiased method for detecting both atrial and ventricular arrhythmias, allowing accurate estimation of arrhythmia burden,” Kerri L. Wiggins, MS, of the University of Washington, and colleagues wrote. “ ... Our study is one of the first to use extended ambulatory monitoring to evaluate the risk of other arrhythmias in relation to kidney function in a community-based sample of adults with and without CKD.”
For their investigation, Wiggins and colleagues included individuals from the Multi-Ethnic Study of Atherosclerosis, the cohort of which was 41% white, 25% African American, 21% Hispanic and 14% Chinese American. Conducting extended ambulatory cardiac monitoring for up to two 14-day periods per participant, researchers considered the following arrythmia outcomes: subclinical AF or atrial flutter lasting greater than 30 seconds, monitor-detected AF/flutter lasting greater than 30 seconds, frequency of premature atrial contractions, frequency of runs of at least 4 beats of supraventricular tachycardia, frequency of premature ventricular contractions, presence of runs of at least 4 beats of ventricular tachycardia and frequency of runs of ventricular tachycardia.
“Strengths of our study include the large number of participants with extended cardiac monitoring, permitting accurate estimation of the burden of supraventricular and ventricular arrhythmias,” Wiggins and colleagues wrote. “[Further], participants ranged in age from 60 to 98 years, an age span during which decreased kidney function and cardiac arrhythmias are common.”
Impact of kidney function on arrythmias
AF/flutter was detected in 7% of the total study population, with 98% having ventricular ectopy and all but one participant having supraventricular ectopy.
Findings indicated that while a doubling of UACR was associated with an increased odds for monitor-detected AF/flutter (odds ratio = 1.18), eGFR was not significantly associated with this outcome. Further, eGFR and UACR did not appear to impact the likelihood for subclinical AF/flutter or ventricular arrythmias, with researchers observing the opposite of what they expected: each 10 mL/min/1.73 m2 increase in eGFR was associated with a 7% greater frequency of supraventricular tachycardia.
“In summary, in a large population of older individuals across a wide range of kidney function, we found little evidence that decreased kidney function was associated with increased monitor-detected arrythmias other than AF,” Wiggins and colleagues concluded. “Additional studies in larger groups of people with CKD are needed to better understand the association of kidney function with subclinical arrhythmias.”
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