Background: The number of patients requiring dialysis is increasing worldwide, and the atrial fibrillation and atrial flutter (AF) prevalence among hemodialysis (HD) patients is higher than in the general population. There have been no studies of Korean AF patients undergoing HD that investigated how AF affects outcomes, such as all-cause mortality, hospitalization, and stroke events. We conducted a large-scale retrospective cohort study with data from the National Health Insurance System to determine how AF affects these outcomes. Methods: In 2013, the Health Insurance Review and Assessment service, a Korean national health insurance scheme, collected data from 21,839 HD patients to evaluate the adequacy of dialysis centers. All-cause mortality, hospitalization, and stroke events were compared between patients with and without AF. Sub-analyses compared these outcomes between AF patients receiving warfarin and those not receiving warfarin. Results: Cox regression analysis found that AF was a significant risk factor for death from any cause (hazard ratio [HR], 1.356; 95% confidence interval [CI], 1.222-1.506; p < 0.001), hospitalization (HR, 1.323; 95% CI, 1.225-1.430; p < 0.001), and hemorrhagic stroke (HR, 1.500; 95% CI, 1.050-2.141; p = 0.026). AF was not significantly associated with an increased risk of ischemic stroke. The use of warfarin was significantly associated with hemorrhagic stroke incidence (HR, 1.593; 95% CI, 1.075-2.360; p = 0.020), while there was no significant correlation between warfarin treatment and all-cause mortality, hospitalization, and ischemic stroke. Conclusion: This cohort study of Korean dialysis patients showed that AF was a risk factor for multiple outcomes among HD patients.
Background: The number of patients requiring dialysis is increasing worldwide, and the atrial fibrillation (AF) prevalence among hemodialysis (HD) patients is higher than in the general population. There have been no studies of Korean AF patients undergoing HD investigating how AF affects outcomes, for example, in terms of all-cause mortality, hospitalization, and stroke events. We conducted a large-scale retrospective cohort study with data from the National Health Insurance System (NHIS) to determine how AF affects these outcomes. Methods: In 2013, the Health Insurance Review and Assessment (HIRA) service, a Korean national health insurance scheme, collected data from 21,839 HD patients for evaluating the adequacy of dialysis centers. All-cause mortality, hospitalization, and stroke events were compared between patients with and without AF. Sub-analyses compared these outcomes between patients receiving and not receiving warfarin. Results: Cox regression analysis found that AF was a significant risk factor for death from any cause (HR, 1.356; 95% CI, 1.222-1.506, P < 0.001), hospitalization (HR, 1.323; 95% CI, 1.225-1.430, P < 0.001), and hemorrhagic stroke (HR, 1.500; 95% CI, 1.050-2.141, P = 0.026). AF was not significantly associated with an increased risk of ischemic stroke. The use of warfarin was significantly associated with hemorrhagic stroke incidence (HR, 1.593; 95% CI, 1.075-2.360, P = 0.020), while there was no significant correlation between warfarin treatment and all-cause mortality, hospitalization, and ischemic stroke. Conclusions: This cohort study of Korean dialysis patients showed that AF was a risk factor for multiple outcomes among HD patients.
BackgroundLupus nephritis is common clinical manifestation and contributes significantly to mortality of systemic lupus erythematosus (SLE)ObjectivesRecently it has been reported that severity of tubulointerstitial inflammation (TII) predicts subsequent renal failure. However, it has not yet been reported what histologic features affect the survival rate in patients with lupus nephritis who had conventional treatment.MethodsSeventy-six patients with lupus nephritis, who had conventional treatment and renal biopsy, were enrolled in this study. The extent of tubulointerstitial lymphocytic infiltrates was semi-quantitated (grade 1–4) using standard histochemical staining. This was then compared to other established lupus nephritis classification (ISN/RPN classification) which focuses on histologic changes of the glomerulus as well as clinical and laboratory characteristics. Follow-up data were obtained and survival analysis was carried out to determine the predictive values for subsequent mortality.ResultsTII was a common pathologic finding, 64% percent of biopsy samples were graded as 1, 11% as 2, 14% as 3, and 11% as 4. In 29% of biopsies (22/76), there were well circumscribed lymphocyte aggregates in tubulointerstitium and 5% of biopsies (4/76), structures like germinal centre (GC) were observed. When TII was divided into mild (grade 1–2) and severe (grade 3–4), lymphocyte aggregates and GC formation were more common in patients with severe TII (15/19, 4/19) than those with mild TII (7/57, 0/57) (p<0.001 and p=0.004, respectively). Patients with severe TII or lymphocyte aggregates were significantly higher in serum creatinine, but not with double-stranded DNA (ds DNA) antibodies, serum complement 3, SLE disease activity (SLEDAI) and degree of proteinuria at the time of biopsies compared to those without. The mean follow-up time was 62.9±47.0 months and overall, 9 patients died as a result of disease progression (n=6) and infection (n=3). Patients with severe TII, lymphocyte aggregates or GC formation were at greater risk for mortality compared to those without. However, both glomerular proliferation and laboratory markers including baseline ds DNA, complement, SLEDAI and degree of proteinuria did not affect on long term mortality. After multivariate logistic analysis including SLEDAI and histologic features, only GC formation provided poor prognostic information for mortality (hazard ratio 24.5, 95% confidence interval 2.2–274.6; p=0.009).ConclusionsTII severity, especially GC formation, was independent predictor for a worse outcome in lupus nephritis patients with conventional treatment. A larger study is needed to confirm whether the presence of GC formation influences disease outcome.Disclosure of InterestNone declared
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