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Kidney Week

Abstract: FR-PO836

A Scoring System to Guide Systemic Oral Anticoagulation Among Incident Dialysis Patients with a Preexisting Diagnosis of Atrial Fibrillation/Flutter

Session Information

Category: Dialysis

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

Authors

  • Albright, Robert C., Mayo Clinic, Rochester, Minnesota, United States
  • Dillon, John J., Mayo Clinic, Rochester, Minnesota, United States
  • Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
Background

Among the general population, patients with atrial fibrillation/flutter (Afib) and a CHA2DS2-VASc score ≥2 have high stroke risk and may receive systemic oral anticoagulation (SOA). Utility of CHA2DS2-VASc in patients initiating hemodialysis (HD) with pre-existing Afib is unclear.

Methods

We considered adult Medicare enrollees who initiated HD at a large US dialysis organization in 2010-2011 with pre-existing Afib, determined from claims. Exposures were risk scores and SOA, based on a prescription fill during the first 3 months of HD. Outcome (stroke/transient ischemic attack [TIA]) was considered from HD start until censoring or study end (Dec 2012), and compared using intention-to-treat principles and Cox proportional hazard models. An HD-specific risk score was developed using a logistic model fit by stepwise elimination of non-contributing variables (p>0.1). Positive outcomes were SOA and no stroke/TIA, and no SOA and stroke/TIA; negative outcomes were the converse.

Results

Among 2742 patients initiating HD with Afib, no association was observed between SOA and risk of stroke/TIA across CHA2DS2-VASc categories. Female sex, Hispanic race, use of a central venous catheter, congestive heart failure, and diabetes defined an HD-specific risk score. In the top quartile of this score, SOA (vs. no SOA) was associated, at near statistical significance, with a lower point estimate for risk of stroke/TIA.

Conclusion

We developed a risk score that, unlike CHA2DS2-VASc, may identify incident HD patients with Afib who will benefit from SOA. Further work is needed to refine and validate this HD-specific score.

Funding

  • Commercial Support