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Abstract: SA-OR51

Impact of ESRD on Stroke Risk in Atrial Fibrillation Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • El Bizri, Abdallah, Staten Island University Hospital, Staten Island, New York, United States
  • Mustafa, Ahmad, Staten Island University Hospital, Staten Island, New York, United States
  • Afif, John Anthony, Staten Island University Hospital, Staten Island, New York, United States
  • Siddiqui, Fasih Sami, Staten Island University Hospital, Staten Island, New York, United States
  • Wei, Chapman, Staten Island University Hospital, Staten Island, New York, United States
  • Khan, Shahkar, Staten Island University Hospital, Staten Island, New York, United States
  • Rizvi, Taqi Ali, Staten Island University Hospital, Staten Island, New York, United States
  • Grovu, Radu C., Staten Island University Hospital, Staten Island, New York, United States
  • El-Charabaty, Elie, Staten Island University Hospital, Staten Island, New York, United States
  • Weinberg, Mitchell, Staten Island University Hospital, Staten Island, New York, United States
  • El Sayegh, Suzanne E., Staten Island University Hospital, Staten Island, New York, United States
Background

Patients with end-stage renal disease (ESRD) are at higher risk of atrial fibrillation (Afib) due to multiple underlying factors. However, the impact of concomitant Afib and ESRD on stroke risk is now well established. The purpose of this study is to evaluate the impact of concomitant Afib and ESRD on stroke risk compared to individuals with Afib alone.

Methods

The national inpatient sample (NIS) database 2016-2018 was used to identify individuals with Afib uaing ICD-10 codes. Patients with age less than 18 or those with history of stroke were excluded. 1:1 propensity matching was used to match patients with ESRD to those without ESRD on different comorbidities. Univariate analysis pre- and post-match were performed. Binary logistic regression was performed after matching to assess whether ESRD was independently associated with stroke risk. A p-value of <0.05 was considered statistically significant.

Results

A total of 1,749,172 patients were included in the study with 89,741 being ESRD. ESRD patients were younger and had higher prevalence of baseline comorbidities except for COPD, CAD, and smoking. Oral anticoagulation use and aspirin use was less in ESRD patients. On univariate analysis, ESRD patients had significantly lower ischemic stroke (1.8% vs 2.9%), hemorrhagic stroke (0.3% vs 0.6%), transient ischemic attack (TIA) (0.4% vs 0.7%). However, mortality was higher in ESRD group (8.1% vs 4.8%). Post-match analysis showed that ESRD patients had significantly lower ischemic stroke [OR: 0.59], hemorrhagic stroke [OR: 0.37] and TIA [OR: 0.76] along with higher mortality [OR: 1.95].

Conclusion

Concomitant presence of Afib and ESRD was associated with a lower stoke rates compared to Afib alone. The platelet dysfunction associated with ESRD along with exposure to heparin during dialysis sessions might explain this decrease in stroke risk. Additional large-scale studies are necessary to validate our findings.

Post-match regression analysis of stroke, hemorrhagic stroke, TIA, and Mortality in ESRD vs No-ESRD patients
 ORCIP-value
Stroke0.590.55-0.63<0.001
Hemorrhagic Stroke0.370.31-0.43<0.001
TIA0.760.65-0.88<0.001
Mortality1.951.87-2.04<0.001