Increased risk of atrial fibrillation in end-stage renal disease patients on dialysis

Abstract

End-stage renal disease (ESRD) patients commonly have a higher risk of developing cardiovascular diseases than general population. Chronic kidney disease is an independent risk factor for atrial fibrillation (AF); however, little is known about the AF risk among ESRD patients with various modalities of renal replacement therapy. We used the Taiwan National Health Insurance Research Database to determine the incident AF among peritoneal dialysis (PD) and hemodialysis (HD) patients in Taiwan.Our ESRD cohort include Taiwan National Health Insurance Research Database, we identified 15,947 patients, who started renal replacement therapy between January 1, 2002 and December 31, 2003. From the same data source, 47,841 controls without ESRD (3 subjects for each patient) were identified randomly and frequency matched by gender, age (±1 year), and the year of the study patient's index date for ESRD between January 1, 2002 and December 31, 2003.During the follow-up period (mean duration: 8–10 years), 3428 individuals developed the new-onset AF. The incidence rate ratios for AF were 2.07 (95% confidence interval [CI] = 1.93–2.23) and 1.78 (95% CI = 1.30–2.44) in HD and PD groups, respectively. After we adjusted for age, gender, and comorbidities, the hazard ratios for the AF risk were 1.46 (95% CI = 1.32–1.61) and 1.32 (95% CI = 1.00–1.83) in HD and PD groups, respectively. ESRD patients with a history of certain comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, heart failure, valvular heart disease, and chronic obstructive pulmonary disease (COPD) have significantly increased risks of AF.This nationwide, population-based study suggests that incidence of AF is increased among dialysis ESRD patients. Furthermore, we have to pay more attention in clinical practice and long-term care for those ESRD patients with a history of certain comorbidities.

Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review

“…The characteristics of the 16 studies are summarized in Table 1 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. All studies were observational and were conducted using registry or cohort databases.…”

“…The total numbers of diabetic patients included were 50,298 receiving PD and 71,532 receiving HD. Eight studies were from Asia [10,11,14,16,18,19,21,23], three were from Australia and New Zealand [15,20,22], three were from Europe [17,24,25], one was from North America [13], and one was from South Africa [12]. Several studies were based on the same registry or cohort databases, such [15,20,22], the Korean Health Insurance Review and Assessment Service (HIRA) database [10,19,21,23], and the National Health Insurance Research Database (NHIRD) of Taiwan [11,16].…”

“…Two studies investigated the effects of dialysis modality on new-onset CVD among diabetic patients [11,19]. Shen et al [11] reported that the risk of new-onset atrial fibrillation was higher in the incident PD group (HR 1.76, 95% CI 1.13-2.75 vs. controls without ESRD) than in the incident HD group (HR 1.52, 95% CI 1.33-1.75vs. controls without ESRD) among 7844 patients with diabetes.…”

Predicting in a predicament: Stroke and hemorrhage risk prediction in dialysis patients with atrial fibrillation

“…The prevalence ranges from 3.8% to 26.5% across countries, with a much higher prevalence in older patients . In hemo‐ and peritoneal dialysis patients, there are 1.5‐fold and 1.3‐fold reported increases in the adjusted risk relative to the general population . Furthermore, the prevalence of atrial fibrillation in dialysis patients is rising, with a threefold increase from 1992 to 2006 in the United States, coinciding with the rising age and comorbidity burden of dialysis patients …”

Dose-Response Between Cardiovascular Risk Factors and Cardiovascular Mortality Among Incident Peritoneal Dialysis Patients

“…The increased CVD mortality risk was found to be associated with dyslipidaemia among patients starting PD treatment the association was not significant. Similarly, in another Chinese PD cohort PD patients with dyslipidaemia was associated with increased risk of atrial fibrillation, but the association was not significant after adjusting the confounders [24]. …”