Atrial fibrillation and associated outcomes in patients with peritoneal dialysis and hemodialysis: a 14-year nationwide population-based study

Chih‐Hsiang Chang; Pei‐Chun Fan; Yu‐Sheng Lin; Shao‐Wei Chen; Ming‐Shyan Lin; Michael Wu; Po‐Cheng Chang; Fen-Chiung Lin; Pao‐Hsien Chu; Victor Chien‐Chia Wu

doi:10.1007/s40620-020-00713-4

February 21, 2020Journal of Nephrology

Atrial fibrillation and associated outcomes in patients with peritoneal dialysis and hemodialysis: a 14-year nationwide population-based study

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Why the study?

Patients with ESRD undergoing dialysis have increased risks of AF, prompting an investigation into dialysis-related incident AF and associated outcomes.

Does peritoneal dialysis reduce the risk of new-onset atrial fibrillation compared to hemodialysis in patients with ESRD?

Structured PICO

Does peritoneal dialysis reduce the risk of new-onset atrial fibrillation compared to hemodialysis in patients with ESRD?

P

Population

117,023 patients with end-stage renal disease (ESRD) undergoing dialysis from the Taiwan National Health Insurance Research Database (2001-2013)

I

Intervention

Peritoneal dialysis (PD) (n=12,659)

C

Comparator

Hemodialysis (HD) (n=104,364)

O

Outcome

New-onset atrial fibrillation (AF)hard clinical

Peritoneal dialysis is associated with a lower risk of incident atrial fibrillation and subsequent hemorrhagic stroke compared to hemodialysis in patients with end-stage renal disease.

Implication

Should not yet change dialysis choice for AF prevention in ESRD; hypothesis-generating association requires randomized confirmation.

Abstract

BACKGROUND: Patients with end-stage renal disease (ESRD) undergoing dialysis have increased risks of atrial fibrillation (AF). OBJECTIVE: To investigate dialysis-related incident AF and associated outcomes. METHODS: Patients with dialysis were retrieved using data from Taiwan National Health Insurance Research Database during 2001-2013. Patients were separated into peritoneal dialysis (PD) and hemodialysis (HD) according to their initial modality. Primary outcome was new-onset AF. Secondary outcomes were AF-associated ischemic stroke (IS)/systemic embolism (SE) and hemorrhagic stroke. RESULTS: A total of 158,910 dialytic patients were retrieved. After exclusion criteria, a total of 117,023 patients with ESRD undergoing dialysis were separated into 12,659 patients on PD and 104,364 patients on HD. There were 458 PD patients with subsequent development of AF, and 6216 HD patients with subsequent development of AF. At end of follow-up, patients on PD and HD had AF incidence densities of 7.8 and 8.8 events per 1000 person-years, the SHR of PD versus HD was 0.83 (95% CI 0.73-0.94). The SHR of PD versus HD was 1.07 (95% CI 0.80-1.44) for IS/SE and the SHR of PD versus HD was 0.34 (95% CI 0.13-0.90) for hemorrhagic stroke. CONCLUSION: In patients with ESRD undergoing dialysis, PD had lowered risks of new onset of AF compared to HD. Subsequently, these AF patients in PD group had comparable incidence of ischemic stroke but decreased incidence of hemorrhagic stroke compared to AF patients in HD group. PD could be the most suitable modality in patients at risk for the onset of AF.