Abstract: FR-PO837

Dialysis Modality and Incident Atrial Fibrillation in Older Patients with ESRD Initiating Dialysis

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
  • Shah, Maulin, Baylor College of Medicine, Houston, Texas, United States
  • Perez, Jose Jesus, Baylor College of Medicine, Houston, Texas, United States
  • Airy, Medha, Baylor College of Medicine, Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background

The incidence of atrial fibrillation (AF) in older patients with ESRD initiating hemodialysis (HD) is high, at 14.8 per 100 person-years, and AF is associated with increased morbidity and mortality. It has been posited that peritoneal dialysis (PD) may confer lower AF risk owing to lesser fluctuations of fluid and electrolyte status. We tested whether the incidence of AF differed between patients using PD versus HD for the initiation of dialysis in a national U.S. cohort.

Methods

Patients 67+ years who initiated dialysis for ESRD in the continental US were eligible if they had been continuously enrolled in Medicare A&B during the 2 years pre- and 90 days post-ESRD. Those with any diagnosis of AF prior to initiation of dialysis (=index date) were excluded. Patients were further required to have exclusively used a single modality for these first 90 days (or until they died or received a transplant during that period). Patients were then followed for AF incidence, which was ascertained from 1 inpatient or 2 outpatient diagnoses (ICD-9 code: 427.3x). Follow-up was terminated 3 years after index date or at loss of Medicare A&B coverage. Death and kidney transplantation were handled as either censoring or competing events in separate analyses. Multivariable Cox proportional hazards regression models were used to estimate the cause-specific and sub-distribution hazard ratios [HR (95% confidence interval)] for PD vs HD.

Results

We identified 251,092 patients with ESRD initiating dialysis between 1996 and 2011; 93.2% used HD and 6.8% used PD. During 447,253 years of follow up, 69,656 patients were newly diagnosed with AF; 3,324 received a kidney transplant and 102,202 died. The unadjusted AF incidence rates per 100 person-years were 15.7 for HD and 14.5 for PD, respectively. The unadjusted cause-specific HR for AF comparing PD to HD (referent) was 0.93 (0.91-0.96) and the sub-distribution HR was 0.97 (0.95-1.00). Multivariable adjustment yielded a cause-specific HR of 1.03 (1.00-1.06) and a sub-distribution HR of 1.00 (0.97-1.03).

Conclusion

In older individuals with ESRD initiating dialysis in the U.S., patients using PD had very similar adjusted rates of AF compared with otherwise similar patients using HD.

Funding

  • NIDDK Support