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Abstract: SA-OR52

Use and Association of Rate Control and Anti-Arrhythmic Medications with Risk of Subsequent Stroke and Mortality Among Hemodialysis Patients with Atrial Fibrillation

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lidgard, Benjamin, University of Washington, Seattle, Washington, United States
  • Zelnick, Leila R., University of Washington, Seattle, Washington, United States
  • An, Jaejin, Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, California, United States
  • Harrison, Teresa N., Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, California, United States
  • Lee, Ming-Sum, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
  • Singer, Daniel E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Bansal, Nisha, University of Washington, Seattle, Washington, United States
Background

Atrial fibrillation (AF) is highly prevalent amongst patients with kidney failure on maintenance dialysis and is associated with poor clinical outcomes. Treatment of AF in this population is particularly challenging, as associations of the core AF management strategies of antiarrhythmic and rate-control medications with clinical outcomes in dialysis patients are unknown.

Methods

We evaluated patients with kidney failure on maintenance dialysis and incident AF from Kaiser Permanente Northern and Southern California. We evaluated associations between time-updated use of rate-control medications alone, antiarrhythmic medications alone, use of both medications, and use of neither medication (referent group) with the composite outcome of ischemic stroke and all-cause mortality using Cox regression models, with adjustment for multiple covariates.

Results

Among a total of 2,100 patients, 44.0% were newly initiated on rate-control medications alone, 4.6% were on antiarrhythmic medications alone, 8.5% were on both, and 42.9% were on neither medication within 12 months of incident AF diagnosis. Over a median (IQR) follow-up of 1.66 (0.45, 3.39) years, we observed 1,406 composite events. Use of antiarrhythmic medications alone (adjusted HR 0.73, 95% CI 0.57-0.95), or both medications (adjusted HR 0.70, 95% CI 0.56-0.88) was associated with lower risk of ischemic stroke or death compared to neither medication use (Table). Use of rate-control medications alone was not associated with decreased risk for the composite outcome.

Conclusion

While the use of antiarrhythmic medications was low in AF patients on maintenance dialysis, antiarrhythmic medication use alone or with rate-control medications was associated with decreased risk of ischemic stroke or all-cause mortality. Future trials are needed to confirm the efficacy and safety of antiarrhythmic medications in dialysis patients.

Funding

  • NIDDK Support