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Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis.

ABSTRACT: Atrial fibrillation (AF) is highly prevalent in dialysis patients, however whether its impact differs between patients on haemodialysis (HD) vs. peritoneal dialysis (PD) is unknown. We aimed to compare the association of AF and clinical outcomes in different dialysis modalities. We performed a population based retrospective cohort study, including adult patients who initiated dialysis between the years 2002 and 2015. Clinical, echocardiographic and laboratory data were reviewed and correlated with outcomes in HD vs. PD. During the study period, 1,130 patients began dialysis. Of the 997 patients without AF before dialysis initiation, 17% developed new-onset AF after the initiation of dialysis (17.3% of HD vs. 13.7% of PD patients, p?=?0.27). Using multivariate analysis, only enlarged left atrium at dialysis initiation (hazard ratio (HR) 2.82, CI95% 2.00-3.99) and age (HR 1.04, CI95% 1.03-1.06) were significantly associated with AF. Dialysis modality was not a significant predictor of AF in either univariate or multivariate analysis. In conclusion, our study demonstrated that AF is common in dialysis patients irrespective of modality. In our cohort, the risk factors associated with AF were older age and enlarged left atrium. AF was associated with increased rates of heart failure and mortality, but not stroke.

SUBMITTER: Abuhasira R

PROVIDER: S-EPMC5813026 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis.

Abuhasira Ran R Mizrakli Yuval Y Shimony Avi A Novack Victor V Shnaider Alla A Haviv Yosef S YS

Scientific reports 20180214 1

Atrial fibrillation (AF) is highly prevalent in dialysis patients, however whether its impact differs between patients on haemodialysis (HD) vs. peritoneal dialysis (PD) is unknown. We aimed to compare the association of AF and clinical outcomes in different dialysis modalities. We performed a population based retrospective cohort study, including adult patients who initiated dialysis between the years 2002 and 2015. Clinical, echocardiographic and laboratory data were reviewed and correlated wi ...[more]

PMID: 29445225

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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.

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Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis.

Publications

Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis.

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