Interleukin-6 Is a Risk Factor for Atrial Fibrillation in Chronic Kidney Disease: Findings from the CRIC Study.

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic kidney disease (CKD). In this study, we examined the association between inflammation and AF in 3,762 adults with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. AF was determined at baseline by self-report and electrocardiogram (ECG). Plasma concentrations of interleukin(IL)-1, IL-1 Receptor antagonist, IL-6, tumor necrosis factor (TNF)-α, transforming growth factor-β, high sensitivity C-Reactive protein, and fibrinogen, measured at baseline. At baseline, 642 subjects had history of AF, but only 44 had AF in ECG recording. During a mean follow-up of 3.7 years, 108 subjects developed new-onset AF. There was no significant association between inflammatory biomarkers and past history of AF. After adjustment for demographic characteristics, comorbid conditions, laboratory values, echocardiographic variables, and medication use, plasma IL-6 level was significantly associated with presence of AF at baseline (Odds ratio [OR], 1.61; 95% confidence interval [CI], 1.21 to 2.14; P = 0.001) and new-onset AF (OR, 1.25; 95% CI, 1.02 to 1.53; P = 0.03). To summarize, plasma IL-6 level is an independent and consistent predictor of AF in patients with CKD

Kaplan-Meier incident atrial fibrillation-free survival estimates by IL-6 tertile.

<p>Kaplan Meier AF-free survival estimates for new-onset AF (in patients who were negative for history of AF or current AF) stratified by IL-6 tertiles. Time to AF differs significantly between tertiles (Log-Rank chi-square = 24.16, df = 2, <i>P</i><0.001).</p

Association between inflammatory biomarkers and atrial fibrillation diagnosed by ECG.

<p>Association between inflammatory biomarkers and atrial fibrillation diagnosed by ECG.</p

Unadjusted and multivariable adjusted association between tertiles of IL-6 and ECG-diagnosed atrial fibrillation at baseline.

<p>Unadjusted and multivariable adjusted association between tertiles of IL-6 and ECG-diagnosed atrial fibrillation at baseline.</p

Unadjusted and multivariable adjusted association between tertiles of IL-6 and new-onset atrial fibrillation during follow-up.

<p>Unadjusted and multivariable adjusted association between tertiles of IL-6 and new-onset atrial fibrillation during follow-up.</p

Baseline characteristics of patients with and without atrial fibrillation^*.

<p>Baseline characteristics of patients with and without atrial fibrillation^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0148189#t001fn001" target="_blank">*</a>}.</p