The Relationship Between Atrial Fibrillation and Chronic Kidney Disease : Epidemiologic and Pathophysiologic Considerations for a Dual Epidemic

Abstract

Atrial fibrillation (AF) presently affects over 2 million Americans, and the magnitude and population burden from AF continues to increase concomitant with the aging of the U.S.

Population: Chronic kidney disease (CKD) is present in 13% of individuals in the U.S., and the prevalence of CKD is also rapidly increasing. The increasing population burden of CKD and AF will profoundly affect the clinical and public health, since CKD and AF are both associated with lower quality of life, increased hospitalization rates, and a greater risk of heart failure, stroke, and total mortality. AF and CKD often co-exist, each condition predisposes to the other, and the co-occurrence of these disorders worsens prognosis relative to either disease alone. The shared epidemiology of CKD and AF may be explained by the strong pathophysiologic connections between these diseases. In order to promote a better understanding of CKD and AF, we have reviewed their shared epidemiology and pathophysiology and described the natural history of patients affected by both diseases.

Figure 1.. Cumulative incidence of Atrial Fibrillation by categories of estimated glomerular filtration rate in whites (top) and blacks (bottom)

From the Atherosclerosis in Communities study. Reprinted with permission from Alonso, A. Circulation 2011

Figure 2.. Mechanisms Linking Atrial Fibrillation to Chronic Kidney Disease

CKD = chronic kidney disease; AF = atrial fibrillation; RAAS = renin-angiotensin-aldosterone system