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

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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.

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Acknowledgements

We would like to thank Alfred Hsing-Fen Lin and Ben Yu-Lin Chou for the statistical assistance during the completion of this manuscript

Funding

Dr. C-H Chang was supported by the Ministry of Science and Technology (106-2314-B-182A-118-MY3).

Author information

Authors and Affiliations

  1. Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan

    Chih-Hsiang Chang & Pei-Chun Fan

  2. Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan City, 333, Taiwan

    Chih-Hsiang Chang & Pei-Chun Fan

  3. Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Yu-Sheng Lin & Ming-Shyan Lin

  4. Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan

    Shao-Wei Chen

  5. Divison of Cardiovascular Medicine, Arrhythmia Services Section, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, USA

    Michael Wu

  6. Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan

    Po-Cheng Chang, Fen-Chiung Lin, Pao-Hsien Chu & Victor Chien-Chia Wu

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  1. Chih-Hsiang Chang
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  2. Pei-Chun Fan
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  7. Po-Cheng Chang
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  10. Victor Chien-Chia Wu
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Corresponding author

Correspondence to Victor Chien-Chia Wu.

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The authors report no conflict of interest.

Research involving human participants and/or animals

No the study involves retrospective database analyses.

Informed consent

The identification number of each patient was encrypted and de-identified to protect their privacy. Therefore informed consent was waived for this study.

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Chang, CH., Fan, PC., Lin, YS. et al. Atrial fibrillation and associated outcomes in patients with peritoneal dialysis and hemodialysis: a 14-year nationwide population-based study. J Nephrol 34, 53–62 (2021). https://doi.org/10.1007/s40620-020-00713-4

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  • DOI: https://doi.org/10.1007/s40620-020-00713-4

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