Hospitalized Atrial Fibrillation After Renal Transplantation in the United States

Abbott, Kevin C.; Reynolds, Joel C.; Taylor, Allen J.; Agodoa, Lawrence Y.

doi:10.1034/j.1600-6143.2003.00071.x

Cited by 35 publications

(31 citation statements)

References 26 publications

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“…The incidence of AF observed in this study was nearly five times that of primary hospitalizations for AF that were reported recently among USRDS registrants during a similar observation period (11). This difference is largely attributable to our inclusion of secondary diagnoses and outpatient events and emphasizes that admissions primarily for AF constitute a minority of presentations.…”

Section: Incidence Of Af After Transplantationsupporting

confidence: 41%

“…The magnitude of the risk relationship between AF and all-cause mortality in this study was more than six times that estimated in the study of patients who were hospitalized for AF by Abbott et al (11), even after adjustment for a broader list of potentially confounding covariates. This difference suggests that consideration of patients with outpatient and secondary inpatient diagnoses as not having AF transfers their mortality risk to the referent sample.…”

Section: Outcomes After Diagnosis Of Afmentioning

confidence: 74%

“…The relative contribution of cardiac arrhythmias to posttransplantation morbidity and mortality is incompletely defined. Using primary hospitalization diagnosis codes, Abbott et al (11) estimated the rate of AF after transplantation at approximately six events per 1000 person-years and found that AF was independently associated with a 34% increase in all-cause mortality. As AF is commonly managed in the outpatient setting or occurs in the hospital as a complication of other conditions, a broader definition is needed to estimate the risk for and implications of this arrhythmia in its usual presentations.…”

mentioning

confidence: 99%

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Incidence, Predictors, and Associated Outcomes of Atrial Fibrillation after Kidney Transplantation

Lentine

Schnitzler

Abbott

et al. 2006

Clinical Journal of the American Society of Nephrology

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The risk for and predictors of atrial fibrillation (AF) after kidney transplantation are not well described. Registry data that were collected by the United States Renal Data System were used to investigate retrospectively new-onset AF among adult first renal allograft recipients and transplant candidates who received a transplant or were wait-listed in 1995 to 2001 with Medicare as the primary payer. AF events were ascertained from billing records, and participants were followed until loss of Medicare coverage or December 31, 2001. Cox hazards analysis was used to identify independent correlates of posttransplantation AF (adjusted hazard ratio [AHR]; 95% confidence interval [CI]) and to examine AF as an outcomes predictor. Among 31,136 eligible transplant recipients, the cumulative incidence of new-onset AF was 3.6% (95% CI 3.4 to 3.8%) and 7.3% (95% CI 7.0 to 7.6%) at 12 and 36 mo and declined below the demographics-adjusted cumulative incidence on the waiting list by approximately 17 mo. Risk factors for posttransplantation AF included older recipient age, male gender, white race, renal failure from hypertension, and coronary artery disease. Extended pretransplantation dialysis duration, posttransplantation diabetes, and graft failure were identified as potentially modifiable correlates of AF. In separate analyses, AF independently predicted death (AHR 3.2; 95% CI 2.9 to 3.6) and death-censored graft loss (AHR 1.9; 95% CI 1.6 to 2.3). As the population of renal transplant recipients grows older, the incidence and prevalence of AF among these patients will likely increase. Appropriate risk stratification may identify transplant recipients who are in need of close monitoring for and management of this adverse cardiovascular event.

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Section: Incidence Of Af After Transplantationsupporting

confidence: 41%

Section: Outcomes After Diagnosis Of Afmentioning

confidence: 74%

mentioning

confidence: 99%

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Incidence, Predictors, and Associated Outcomes of Atrial Fibrillation after Kidney Transplantation

Lentine

Schnitzler

Abbott

et al. 2006

Clinical Journal of the American Society of Nephrology

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“…All 3 studies were based in the United States Renal Data System Registry, but varied in case definitions (only hospitalized CHF versus combined inpatient and outpatient diagnoses) and years of transplant for participants (ranging from 1995-2001). Two registry studies examined AF risk in relation to BMI, one of which found that BMI >28.3 independently predicted a 79% relative increase in the risk of hospitalized AF compared to lower BMI (17). In the second study of AF including outpatient events, obesity was a significant correlate in bivariate analyses but the association was not significant in the final multivariable model (18).…”

Section: Resultsmentioning

confidence: 99%

Obesity and Cardiac Risk After Kidney Transplantation: Experience at One Center and Comprehensive Literature Review

et al. 2008

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Background The cardiac implications of obesity in kidney transplant recipients are not well-described. Methods We examined associations of body mass index (BMI) at transplant with post-transplant cardiac risk among 1,102 renal allograft recipients at a single center in 1991-2004. Cumulative post-transplant incidences of congestive heart failure (CHF), atrial fibrillation (AF), myocardial infarction (MI), and a composite of these cardiac diagnoses were estimated by the Kaplan-Meier method. Bivariate (hazards ratio, HR) and covariate-adjusted (aHR) relationships of BMI increments with cardiac risk were modeled by Cox's regression. We also systematically reviewed the literature on BMI and cardiac events after transplant. Results In the local data, 5-year cumulative incidence of any cardiac diagnosis rose from 8.67% to 29.35% across the lowest to highest BMI quartiles (P=0.02), driven primarily by increases in CHF and AF. In contrast, the rate of MI did not differ by BMI quartile (P=0.56). Each 5 U BMI increase predicted 26 % higher risk of the cardiac composite (HR 1.26, 95% CI 1.06 −1.48 2.14, P=0.008), a relationship that persisted with significance after covariate adjustment (aHR 1.19, 95% CI 1.00 −1.43, P=0.049). BMI independently predicted cardiac risk in sub-cohorts with pre-transplant heart disease and with non-diabetic renal failure. Data from 26 original articles support BMI as a risk factor for post-transplant CHF and AF, whereas findings for coronary/ischemic outcomes are inconsistent and predominantly negative. Conclusions High BMI at transplant predicts increased cardiac risk, especially of CHF and AF. Further research should examine whether obesity treatment modifies cardiac risk after kidney transplantation.

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“…In one registry study, a BMI > 28.3 independently predicted a 79% relative increase in the risk of hospitalized atrial fibrillation compared with a BMI of ≤ 28.3. 37 The impact of BMI on cardiac-related death has been shown to follow a U-shaped risk. In a large registry study consisting of 51,927 renal allograft recipients, the adjusted risk of cardiac death increased at both low and high BMI compared to a reference group with a BMI of 22-24 (aHR 1.3 for BMI < 20; aHR 1.2 for BMI 30-32; aHR 1.4 for BMI > 36).…”

Section: Obesitymentioning

confidence: 99%

Post-transplant Cardiovascular Disease

Pham

Slavov

Pham³

et al. 2010

Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients

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Hospitalized Atrial Fibrillation After Renal Transplantation in the United States

Cited by 35 publications

References 26 publications

Incidence, Predictors, and Associated Outcomes of Atrial Fibrillation after Kidney Transplantation

Incidence, Predictors, and Associated Outcomes of Atrial Fibrillation after Kidney Transplantation

Obesity and Cardiac Risk After Kidney Transplantation: Experience at One Center and Comprehensive Literature Review

Post-transplant Cardiovascular Disease

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