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Abstract: SA-PO146

Atrial Fibrillation Chronicity in Patients with AKI on Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Shawwa, Khaled, Mayo Clinic, Rochester, Minnesota, United States
  • Kompotiatis, Panagiotis, Mayo Clinic, Rochester, Minnesota, United States
  • Bobart, Shane A., Mayo Clinic, Rochester, Minnesota, United States
  • Wiley, Brandon M., Mayo Clinic, Rochester, Minnesota, United States
  • Jentzer, Jacob, Mayo Clinic, Rochester, Minnesota, United States
  • Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
Background

Atrial fibrillation (AF) has been reported in 44% of patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), but the chronicity of AF remains unclear. We aim to assess the epidemiology and outcomes of AF among AKI patients receiving CRRT, including predictors of new-onset AF (NOAF) on CRRT.

Methods

This is a retrospective analysis of a cohort of patients admitted to the ICUs at a tertiary care hospital from 12/2006 through 11/2015 who had AKI and received CRRT. The primary outcome was mortality at three years, which was assessed using a Cox proportional hazard model. Secondary outcomes included in-hospital mortality. AF was ascertained by manually reviewing the chart. A random sample of 10% of cohort was independently reviewed by another investigator and agreement was reported using kappa coefficient.

Results

Out of 1,394 CRRT patients who had AKI, 582 patients did not have any arrhythmia. There were 419 (30%) patients who were known to have AF prior to starting CRRT. NOAF occurring while on CRRT developed in 193 (14%) patients. Another 160 patients (11.5%) developed NOAF during their index ICU admission prior to initiation of CRRT. Kappa was 0.95 (95% CI: 0.87-1, p<.001). A known history of AF (HR: 1.19, 95%CI: 1.01-1.41, p=0.04) and NOAF occurring on CRRT (HR: 1.27, 95% CI: 1.04-1.56, p=0.02) were independently associated with an increased hazard of death at 3 years, compared to the group who did not have any arrhythmia. There was no difference in in-hospital mortality between the AF groups. The models were adjusted for age, sex, BMI, SOFA score at CRRT initiation, baseline serum creatinine, Charlson comorbidity index, number of vasopressors used in the ICU, use of invasive ventilation. In multivariate analysis, using time-dependent covariates, higher potassium (HR 1.24, 95%CI: 1.01- 1.54, p=0.043) and bicarbonate (HR 0.95, 95%CI: 0.92-0.98, p=0.003) were associated with increased and decreased risk of NOAF on CRRT, respectively.

Conclusion

Incident NOAF in critically ill patients with AKI receiving CRRT is common and carries an unfavorable prognosis similar to patients with prevalent AF. Further studies are required to elucidate modifiable risk factors for NOAF occurring on CRRT and the mechanisms driving the observed association with adverse outcomes.