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

Abstract

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.

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

“…Results were similar in sensitivity analyses that incorporated censoring at waiting list removal for indications other than transplantation. These findings resonate with recent evidence of reduced risk for cardiac morbidity and mortality after transplantation but increased risk after graft loss (2)(3)(4)(5)(6)25,26). This study is limited by its retrospective design and our inability to confirm objectively clinically coded diagnoses.…”

“…older donor age, donor hypertension, and delayed graft function with increased risk for cardiac events after transplantation (3,5,6). These findings may be mediated by adverse relationships with long-term allograft function.…”

“…Lower rates of cardiac death (2) and specific cardiac complications including myocardial infarction (3,4), congestive heart failure (5), and atrial fibrillation (6) have been reported among transplant recipients compared with transplant candidates on the waiting list; however, less is known about the epidemiology of cerebrovascular disease events (CVE) in ESRD or the potential for modification of CVE risk with transplantation. Whereas an analysis of American dialysis patients tracked in the Dialysis Morbidity and Mortality cohort of the United States Renal Data System (USRDS) found that kidney transplantation was associated with markedly reduced risk for stroke compared with dialysis (7), lack of information on waiting list membership prevents distinction of the benefits of transplantation from selection bias as a result of characteristics conferring transplant candidacy.…”

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

“…2,3 Observational data suggest particularly high frequencies of cardiovascular events in the first months after kidney transplantation. 2,4,5 Cardiovascular diseases in aggregate make up the most common cause of death in patients with functioning allografts at all times after kidney transplantation, accounting for 30% of mortality overall, with highest rates in the peritransplantation period. 6 Guidelines and position papers by national organizations can serve as useful tools for informing cardiac evaluation practices before noncardiac surgery.…”

An acute renal infarction due to atrial fibrillation in a transplant patient: a case report

“…New onset AF is common after kidney transplantation and is associated with markedly increased risk for death and death censored graft loss. [9] Early diagnosis of renal artery thromboembolism is difficult. It is not usually diagnosed at the onset of symptoms and early identification is made in <30% of the patients.…”