Atrial fibrillation in DM tied to end-stage renal disease

Patients with diabetes mellitus (DM) who also have atrial fibrillation (AF) are at a heightened risk of developing end-stage renal disease (ESRD), a recent study has found.

Researchers retrieved data of 6,105 DM patients with AF from Taiwan’s National Health Insurance Research Database. Participants were compared against a propensity score-matched cohort of 6,105 DM counterparts without AF. Both groups were followed until death, dialysis, or 31 December 2013, whichever occurred first. The primary endpoint was ESRD.

Cox proportional hazard regression analysis revealed that the presence of AF aggravated the risk of ESRD in DM patients by 18 percent (adjusted hazard ratio [HR], 1.18, 95 percent confidence interval [CI], 1.01–1.46; p=0.043). Hypertension had a similar but stronger effect, increasing the risk of ESRD by nearly 90 percent (adjusted HR, 1.89, 95 percent CI, 1.46–2.42; p<0.001).

Chronic kidney disease (adjusted HR, 6.35, 95 percent CI, 4.80—8.41; p<0.001) and a high Charlson Comorbidity Index score (score 5–9: adjusted HR, 7.53, 95 percent CI, 3.07–18.45; p<0.001; score ≥10: adjusted HR, 13.25, 95 percent CI, 5.39–32.58; p<0.001) were likewise strong correlates of ESRD in DM patients.

“Our findings suggest that patients with DM should be closely monitored for irregular or rapid heart rates,” the researchers said.

“Further research remains necessary to delineate contributing factors that lead to AF development in the setting of DM and elucidate potential modifiable pathways through which AF contributes to the progression to ESRD,” they added.