Atrial fibrillation in chronic dialysis patients in the United states: risk factors for hospitalization and mortality

Abstract

BackgroundThe incidence and risk factors for hospitalized atrial fibrillation have not been previously assessed in a national population of dialysis patients.MethodsWe analyzed the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave II in a historical cohort study of hospitalized atrial fibrillation. Data from 3374 patients who started dialysis in 1996 with valid follow-up times were available for analysis, censored at the time of renal transplantation and followed until November 2000. Cox Regression analysis was used to model factors associated with time to first hospitalization for atrial fibrillation (ICD9 code 427.31x) adjusted for comorbidities, demographic factors, baseline laboratory values, blood pressures, dialysis modality, and cardioprotective medications.ResultsThe incidence density of atrial fibrillation was 12.5/1000 person years. Factors associated with atrial fibrillation were older age (> = 71 years vs. <48 years), extremes (both high and low) of pre-dialysis systolic blood pressure, dialysis modality (hemodialysis vs. peritoneal dialysis), and digoxin use. Baseline use of coumadin was associated with reduced mortality in patients later hospitalized for atrial fibrillation.ConclusionsDialysis patients had a high incidence of atrial fibrillation. This risk was largely segregated among those with established risk factors for atrial fibrillation, and hemodialysis patients. Use of coumadin was associated with improved survival among patients later hospitalized for atrial fibrillation.

353 Prevalence of Chronic Atrial Fibrillation in Dialysis Patients

“…As such, previously-reported findings of associations between various patient factors, at least those identified upon dialysis initiation, and chronic AF can be robustly quantified. As expected, we echoed the finding of the association of age with AF reported by Wizemann et al in the DOPPS database 8 , Abbott et al (in a univariate analysis) in Dialysis Morbidity and Mortality (DMMS) Wave II study 18 , Vasquez et al in their small but well-studied incident dialysis cohort 11 , and others 5,7 . Both Abbott et al and Wizemann et al also found Caucasian race to be associated with AF 8,18 .…”

“…As expected, we echoed the finding of the association of age with AF reported by Wizemann et al in the DOPPS database 8 , Abbott et al (in a univariate analysis) in Dialysis Morbidity and Mortality (DMMS) Wave II study 18 , Vasquez et al in their small but well-studied incident dialysis cohort 11 , and others 5,7 . Both Abbott et al and Wizemann et al also found Caucasian race to be associated with AF 8,18 . The DOPPS investigators also found BMI to be significantly correlated in direct fashion with preexisting AF 8 .…”

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

“…Another study found no difference (P ϭ 0.4) in the incidence of stroke when comparing an "undertreated" population (24% prevalence of warfarin use in patients with atrial fibrillation; n ϭ 127) with patients without atrial fibrillation (n ϭ 349) in the same cohort. 41 Abbott et al 42 reported a survival advantage in 123 hospitalized dialysis patients who had atrial fibrillation and were on warfarin; however, the results apply to a specific subpopulation of patients who survived hospitalization for atrial fibrillation and were presumed to be on warfarin before admission to hospital. 42 Overall, limited hypotheses can be generated from these studies because of methodologic limitations and small sample sizes.…”

Electrocardiographic findings in chronic hemodialysis patients

“…13,14 Nós mostramos baixa prevalência de FA quando comparado a outros dados publicados em pacientes sob hemodiálise. Acar et al 13 encontraram prevalên-cia de 13,1% em uma análise de 183 pacientes com idade média de 52 anos e tempo médio de TRS de 41,6 meses, características semelhantes às encontradas em nossa amostra populacional; os pacientes com FA tinham idade média de 64,9 ± 9,8 estatisticamente mais elevada que o grupo sem FA que era de 49,9 ± 16,6 (p < 0,001).…”