Background:Atrial fibrillation (AF) and chronic kidney disease (CKD) are known risk factors for each other. In Tama City in Tokyo, 12-lead ECG and serum creatinine concentration have been included as essential examinations in specific health checkups to diagnose AF and CKD. In the present study, we investigated the impact of CKD classification on new-onset AF in the general population.

Methods and Results:Among 13,478 subjects aged 40–74 years at entry (age, 65.6±7.8 years; men, 42.0%), renal impairment with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²and proteinuria were found in 15.5% and 4.6%, respectively. CKD severity in individual subjects was classified according to a heatmap of the Japanese Society of Nephrology as 81.3% in the green, 15.1% in the yellow, 2.5% in the orange, and 0.9% in the red. Of those without AF in 2012, it had developed in 115 up to 2017; thus, the new-onset AF incidence rate was 2.6/1,000 person-years. Hazard ratios and 95% confidence intervals for new-onset AF in each CKD classification were 1.50 (0.93–2.41, P=0.097) in the yellow, 2.53 (1.03–6.23, P=0.044) in the orange, and 4.65 (1.47–14.70, P=0.009) in the red compared with the green as a reference.

Conclusions:CKD classification was significantly associated with new-onset AF in the general population. Thus, it would be useful for risk stratification of new-onset AF. Renal function evaluation is recommended in health checkups.

背景：心房颤动 (AF) 和慢性肾病 (CKD) 是彼此已知的危险因素。在东京多摩市，12 导联心电图和血清肌酐浓度已被列为特定健康检查的必要检查，以诊断 AF 和 CKD。在本研究中，我们调查了 CKD 分类对一般人群新发 AF 的影响。

方法和结果：在 13,478 名入组时年龄在 40-74 岁（年龄，65.6±7.8 岁；男性，42.0%）的受试者中，肾功能受损，估计肾小球滤过率 (eGFR) <60 mL/min/1.73 m ²和蛋白尿分别占 15.5% 和 4.6%。根据日本肾脏病学会的热图，个体受试者的 CKD 严重程度分为绿色 81.3%、黄色 15.1%、橙色 2.5% 和红色 0.9%。在 2012 年未发生 AF 的患者中，截至 2017 年有 115 例；因此，新发 AF 的发病率为 2.6/1,000 人年。在每种 CKD 分类中，新发 AF 的风险比和 95% 置信区间在黄色中为 1.50（0.93-2.41，P=0.097），在橙色中为 2.53（1.03-6.23，P=0.044）和 4.65（1.47-） 14.70, P=0.009) 以红色为参照，以绿色为参照。

结论： CKD 分类与一般人群新发 AF 显着相关。因此，这对于新发 AF 的风险分层是有用的。健康检查时建议进行肾功能评估。