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Abstract: TH-PO158

Association of Parathyroid Hormone Concentration with Incident Atrial Fibrillation in Older Persons with Kidney Failure Initiating Dialysis

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Khairallah, Pascale, Baylor College of Medicine, Houston, Texas, United States
  • Liu, Sai, Stanford University School of Medicine, Stanford, California, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States
  • Chang, Tara I., Stanford University School of Medicine, Stanford, California, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background

Atrial fibrillaton (AF) is common in persons with kidney failure on hemodialysis (KF-HD). In the general population, higher intact parathyroid hormone (iPTH) levels were found to be associated with presence of AF. Whether iPTH associates with AF in patients with KF-HD is unknown.

Methods

Using merged USRDS-DaVita data (2006-2011) we selected persons aged 67+ years who initiated HD and survived 120 days. Eligible persons had continuous Medicare A+B coverage from 2 years prior to KF and no diagnosis of AF. Sociodemographic, comorbidity, and clinical information was abstracted from Medicare forms, billing claims, and electronic health records. iPTH was categorized consistent with work by Block et al (JASN 2004). Patients were followed for incident (ie, newly-diagnosed) AF as reflected in inpatient and outpatient claims. Unadjusted and multivariable Cox regression was used to estimate the associations of time-updated iPTH category (ref: 150-<300 pg/mL) with incident AF.

Results

Of 15,225 patients initiating HD, surviving 120 days, and without a prior diagnosis of AF, iPTH (in pg/mL) at baseline was <150 in 4479, 150-<300 in 5964, 300-<600 in 3479, and ≥600 in 1064 persons. During 21,845 patient-years 2857 patients had incident AF (rate, 13.1/100 person-years). Hazard ratios with increasing levels of adjustment are shown in the Figure. After multivariable adjustment, patients with iPTH<150 pg/mL had 13% (95% CI, 3-25%) higher AF incidence compared with the 150-<300 pg/mL group, but no association was found for those with iPTH 300-<600 or iPTH ≥600 pg/mL.

Conclusion

Among persons with incident KF-HD, compared with those whose iPTH was between 150 and <300 pg/mL, lower iPTH was independently associated with higher AF incidence; however, no association with AF was identified for higher iPTH levels.

Models: 1) unadjusted; 2) +socio-demographics; 3) +comorbidities & clinical variables; 4) +calcium & phosphorus.

Funding

  • NIDDK Support