Clinical outcomes among hemodialysis patients with atrial fibrillation: a Korean nationwide population-based study

Kang, Yeunmi; Choi, Han Sung; Kwon, Young Eun; Shin, Ji Hyeon; Won, Eun Mi; Yang, Ki Hwa; Oh, Hyung Jung; Ryu, Dong Ryeol

doi:10.23876/j.krcp.20.022

Cited by 12 publications

(12 citation statements)

References 21 publications

(23 reference statements)

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“…AF at the commencement of HD was related to an increased mortality risk of ESKD patients in all age groups [23]. AF was a risk factor for outcomes in the HD population, such as death from any cause, hospitalization, and hemorrhagic stroke [24].…”

Section: Discussionmentioning

confidence: 94%

Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA2DS2-VASc Score

Tourountzis,

Lioulios,

Stasini

et al. 2024

Medicina

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Background and Objectives: Cardiovascular events are the major cause of morbidity and mortality in patients on hemodialysis (HD). Identifying risk factors can help in the effort to reduce cardiovascular risk and improve life expectancy. The objective of this study was to evaluate the ability of the CHA2DS2-VASc score—the risk index of stroke in atrial fibrillation (AF)—to predict strokes, major cardiovascular events, and mortality in patients with end-stage kidney disease. Materials and Methods: The CHA2DS2-VASc and HAS-BLED scores (the bleeding risk from the use of anticoagulation in AF) were calculated in 237 HD patients, 99 women with a median age of 76 (15) years, at the time they commenced HD. The scores’ ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Among the exclusion criteria were the change of dialysis method or loss of follow-up, HD due to acute renal failure, and incompliance with medical instructions, thus the sample is not representative of a broader population. Results: The CHA2DS2-VASc score was higher in AF (n = 69) compared to non-AF (n = 168) patients, 5 (2.5) vs. 4 (2), p < 0.0001, respectively. An increased CHA2DS2-VASc score was correlated with cardiovascular events, namely, heart failure (p = 0.007, p = 0.024), stroke (p < 0.0001, p < 0.0001), and risk of all-cause mortality (p < 0.0001, p < 0.0001) in AF and non-AF groups, respectively. The C statistics indicated that the referred score showed modest discrimination in AF and non-AF patients on HD for heart failure, stroke, and all-cause mortality, however for cardiovascular mortality this was found only in the AF group. Conclusions: An increased CHA2DS2-VASc score at the time of HD initiation can predict strokes, heart failure, and all-cause mortality in HD patients independent of the presence of AF. The risk of cardiovascular mortality could only be predicted in patients with AF.

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Section: Discussionmentioning

confidence: 94%

Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA2DS2-VASc Score

Tourountzis,

Lioulios,

Stasini

et al. 2024

Medicina

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“…The HD quality assessment also collected data from each HD facility through a web-based data-collection system [ 18 ]. The collected data include 12 measures in three domains (structure, process, and monitoring) ( Supplementary Table 1 , available online).…”

Section: Methodsmentioning

confidence: 99%

Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study

Park

Kim

Cho

et al. 2023

Kidney Res Clin Pract

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Background: It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. Methods: We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. Results: After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; p = 0.004). Conclusion: Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.

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“…Patients who were admitted during assessment or lost to follow up were excluded from the analysis [ 15 ]. Additionally, the HD quality assessment collected data from each HD facility through a web-based data-collection system [ 16 , 17 ].…”

Section: The Current Challenges In Kidney Health In Koreamentioning

confidence: 99%

Kidney Health Plan 2033 in Korea: bridging the gap between the present and the future

Kim,

Hyun,

Cha

et al. 2024

Kidney Res Clin Pract

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In response to the increase in the prevalence of chronic kidney disease (CKD) in Korea, the growth of patients requiring renal replacement therapy and the subsequent increase in medical costs, the rapid expansion of patients with end-stage kidney disease (ESKD), and the decrease in patients receiving home therapy, including peritoneal dialysis, the Korean Society of Nephrology has proclaimed the new policy, Kidney Health Plan 2033 (KHP 2033). KHP 2033 would serve as a milestone to bridge the current issues to a future solution by directing the prevention and progression of CKD and ESKD, particularly diabetic kidney disease, and increasing the proportion of home therapy, thereby reducing the socioeconomic burden of kidney disease and improving the quality of life. Here, we provide the background for the necessity of KHP 2033, as well as the contents of KHP 2033, and enlighten the Korean Society of Nephrology’s future goals. Together with patients, healthcare providers, academic societies, and national policymakers, we need to move forward with goal-oriented drive and leadership to achieve these goals.

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Clinical outcomes among hemodialysis patients with atrial fibrillation: a Korean nationwide population-based study

Cited by 12 publications

References 21 publications

Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA2DS2-VASc Score

Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA2DS2-VASc Score

Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study

Kidney Health Plan 2033 in Korea: bridging the gap between the present and the future

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