Dataset Information

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan.

ABSTRACT:

Background

While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known.

Methods

Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area.

Results

The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88-3.19) in all dialysis patients, 1.80 (95% CI, 1.30-2.29) in male dialysis patients, and 2.13 (95% CI, 0.66-3.61) in female dialysis patients.

Conclusions

The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.

SUBMITTER: Ohsawa M

PROVIDER: S-EPMC4848326 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Publications

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan.

Ohsawa Masaki M Tanno Kozo K Okamura Tomonori T Yonekura Yuki Y Kato Karen K Fujishima Yosuke Y Obara Wataru W Abe Takaya T Itai Kazuyoshi K Ogasawara Kuniaki K Omama Shinichi S Turin Tanvir Chowdhury TC Miyamatsu Naomi N Ishibashi Yasuhiro Y Morino Yoshihiro Y Itoh Tomonori T Onoda Toshiyuki T Kuribayashi Toru T Makita Shinji S Yoshida Yuki Y Nakamura Motoyuki M Tanaka Fumitaka F Ohta Mutsuko M Sakata Kiyomi K Okayama Akira A

Journal of epidemiology 20160123 5

<h4>Background</h4>While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known.<h4>Methods</h4>Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area.<h4>Results</h4>The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, resp ...[more]

PMID: 26804038

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Project description:RATIONALE & OBJECTIVE:Atrial fibrillation (AF) is common in patients with kidney failure treated by maintenance dialysis. Whether the incidence of AF differs between patients receiving hemodialysis and peritoneal dialysis is uncertain. STUDY DESIGN:Retrospective cohort study. SETTING & PARTICIPANTS:Using the US Renal Data System, we identified older patients (?67 years) with Medicare Parts A and B who initiated dialysis therapy (1996-2011) without a diagnosis of AF during the prior 2 years. EXPOSURE:Dialysis modality at incident end-stage renal disease (ESRD) and maintained for at least 90 days. OUTCOME:Patients were followed up for 36 months or less for a new diagnosis of AF. ANALYTICAL APPROACH:Time-to-event analysis using multivariable Cox proportional hazards regression to estimate cause-specific HRs while censoring at modality switch, kidney transplantation, or death. RESULTS:Overall, 271,722 older patients were eligible; 17,487 (6.9%) were treated with peritoneal dialysis, and 254,235 (93.1%), with hemodialysis, at the onset of ESRD. During 406,225 person-years of follow-up, 69,705 patients had AF newly diagnosed. Because the proportionality assumption was violated, we introduced an interaction term between time (first 90 days vs thereafter) and modality. The AF incidence during the first 90 days was 187/1,000 person-years on peritoneal dialysis therapy and 372/1,000 person-years on hemodialysis therapy. Patients on peritoneal dialysis therapy had an adjusted 39% (95% CI, 34%-43%) lower incidence of AF than those on hemodialysis therapy. From day 91 onward, AF incidence was ?140/1,000 person-years with no major difference between modalities. LIMITATIONS:Residual confounding from unobserved differences between exposure groups; ascertainment of AF from billing claims; study of first modality may not generalize to patients switching modalities; uncertain generalizability to younger patients. CONCLUSIONS:Although patients initiating dialysis therapy using peritoneal dialysis had a lower AF incidence during the first 90 days of ESRD, there was no major difference in AF incidence thereafter. The value of interventions to reduce the early excess AF risk in patients receiving hemodialysis may warrant further study.

Project description:Background and objectivesThe relative efficacy and safety of apixaban compared with no anticoagulation have not been studied in patients on maintenance dialysis with atrial fibrillation. We aimed to determine whether apixaban is associated with better clinical outcomes compared with no anticoagulation in this population.Design, setting, participants, & measurementsThis retrospective cohort study used 2012-2015 US Renal Data System data. Patients on maintenance dialysis with incident, nonvalvular atrial fibrillation treated with apixaban (521 patients) were matched for relevant baseline characteristics with patients not treated with any anticoagulant agent (1561 patients) using a propensity score. The primary outcome was hospital admission for a new stroke (ischemic or hemorrhagic), transient ischemic attack, or systemic thromboembolism. The secondary outcome was fatal or intracranial bleeding. Competing risk survival models were used.ResultsCompared with no anticoagulation, apixaban was not associated with lower incidence of the primary outcome: hazard ratio, 1.24; 95% confidence interval, 0.69 to 2.23; P=0.47. A significantly higher incidence of fatal or intracranial bleeding was observed with apixaban compared with no treatment: hazard ratio, 2.74; 95% confidence interval, 1.37 to 5.47; P=0.004. A trend toward fewer ischemic but more hemorrhagic strokes was seen with apixaban compared with no treatment. No significant difference in the composite outcome of myocardial infarction or ischemic stroke was seen with apixaban compared with no treatment. Compared with no anticoagulation, a significantly higher rate of the primary outcome and a significantly higher incidence of fatal or intracranial bleeding and of hemorrhagic stroke were seen in the subgroup of patients treated with the standard apixaban dose (5 mg twice daily) but not in patients who received the reduced apixaban dose (2.5 mg twice daily).ConclusionsIn patients with kidney failure and nonvalvular atrial fibrillation, treatment with apixaban was not associated with a lower incidence of new stroke, transient ischemic attack, or systemic thromboembolism but was associated with a higher incidence of fatal or intracranial bleeding.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_05_29_CJN11650919.mp3.

Dataset Information

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan.

Background

Methods

Results

Conclusions

Publications

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan.

Similar Datasets

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