Recovery from Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-based Cohort Study

Abstract

Background: While proteinuria is recognized as a risk factor for atrial fibrillation (AF), it can exhibit both reversible and persistent courses. Our objective was to examine the relationship between the change in status for proteinuria and the risk of AF in a longitudinal cohort study on the general population nationwide. Methods: We included participants (n = 1,708,103) who underwent consecutive health examinations. The presence of proteinuria was determined by dipstick urinalysis results. The outcome was the occurrence of AF (International Classification of Diseases-10 code: I48). Results: All included participants, 1,666,111 (97.5%), 17,659 (1.0%), 19,696 (1.2%), and 4,637 (0.3%), were categorized into groups of proteinuria-free, recovered, developed, and chronic, respectively. The median interval between health screenings was 21.5 months. During a median follow-up of 14.5 years, 41,190 (2.4%) cases of AF occurred. In the multivariable analysis, the risk of AF occurring in the proteinuria-recovered group, (hazard ratio (HR): 1.198, 95% confidence interval (CI): 1.109–1.293, ***P < 0.001), proteinuria-developed group (HR: 1.456, 95% CI: 1.362–1.558, ***P < 0.001) and proteinuria-chronic group (HR: 1.656, 95% CI: 1.476–1.858, ***P < 0.001), were higher than in the proteinuria-free group. In a further pairwise comparison, the proteinuria-recovered group had a relatively lower risk of AF compared to the proteinuria-chronic group (HR: 0.751, 95% CI: 0.652–0.865, ***P < 0.001). Conclusion: Our study showed that the risk of AF can change according to alterations in proteinuria status. Notably, recovering from proteinuria can also be considered a modifiable risk factor for AF.