Frequent Premature Atrial Contractions Are Associated with Increased Mortality Risk and Poor Kidney Outcomes in Patients with CKD

Background: Frequent premature atrial contractions (PACs) are associated with atrial fibrillation, cardiovascular events, and death in general population. However, the prognostic significance of PAC burden is not fully elucidated in patients with chronic kidney disease (CKD). This study aims to examine the association between PACs and the risks of all-cause mortality and end-stage kidney disease (ESKD) in non-dialysis CKD patients. Methods: This retrospective study included 2303 CKD patients receiving 24-hour Holter recording from Kaohsiung Medical University Hospital Health care system between April 2009 and November 2021. Patients were categorized into two groups based on PAC burden, with frequent PACs defined as ≥500 PACs per 24 hours. Cox regression analyses, survival analysis, and subgroup analysis were performed to evaluate the impact of PACs on death and ESKD. Results: The Kaplan-Meier curve demonstrated a ≥500 PACs group was associated with a higher death risk than < 500 PACs group. In multivariable-adjusted model, frequent PACs were associated with increased all-cause mortality (Hazard Ratio [HR] 1.48, 95% confidence interval [CI] 1.26-1.73, p <0.001) and progression to ESKD (HR 1.37, 95% CI 1.07-1.76, p=0.012). In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups, especially in those with high Kidney Disease Improving Global Outcomes (KDIGO) risk categories. Conclusion: Frequent PACs were associated with all-cause mortality and poor renal outcomes. Further studies are required to examine the implication of therapeutic strategies in CKD patients with PACs, in order to prevent potential subsequent adverse outcomes.K-M curve of PACs and survival