Kidney Week

Abstract: TH-PO0527

Frequent Premature Atrial Contractions Associated with Increased Risk of Acute Ischemic Stroke Risk in ESKD Population

Session Information

• Dialysis: Novel Therapeutics and Medication Management
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Chen, Yun-Ping, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Yun-Ping Chen, MD

• Lu, Lu Heng, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Lu Heng Lu

• Kuo, Mei-Chuan, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Mei-Chuan Kuo, MD

• Huang, TengHui, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

TengHui Huang, MS

• Lin, Ming-Yen, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Ming-Yen Lin, PhD

• Lin, Yi-Ting, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Yi-Ting Lin, MD, PhD

• Chiu, Yi-Wen, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Yi-Wen Chiu, MD

• Hwang, Shang-Jyh, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Shang-Jyh Hwang, MD

• Wu, Ping-Hsun, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Ping-Hsun Wu, MD, MS, PhD

Background

Cardiac arrhythmias are common in end-stage kidney disease (ESKD) patients. Growing evidence has highlighted the clinical significance of frequent premature atrial contractions (PACs). Beyond their link with increased incidence of atrial fibrillation, several studies in the general population have shown that frequent PACs are correlated with a higher risk of acute ischemic stroke. However, limited research has examined this association in the ESKD population. Our study aims to evaluate the risk of acute ischemic stroke associated with frequent PACs in individuals with ESKD receiving renal replacement therapy (RRT).

Methods

Prevalent ESKD patients examined 24-hour Holter scan were recruited in the Kaohsiung Medical University Hospital healthcare system from April 2009 to December 2021. The total PAC counts were calculated, and the frequent PACs were defined with a cutoff value of 500 beats per day. The relationship between frequent PACs and acute ischemic stroke was analyzed using survival analysis and the multivariable-adjusted Cox regression model. The covariates consist of the components of the CHA₂DS₂-VASc score, including age, gender, and cardiovascular comorbidities.

Results

After excluding individuals with a history of acute ischemic stroke and/or atrial fibrillation (AF), newly identified AF and/or atrial flutter on 24-hour Holter scan, and individual with missing data, 369 ESKD patients were enrolled as baseline free of stroke or atrial fibrillation for final analysis. The Kaplan-Meier curve indicated that individuals with PACs greater than 500 beats per day were corelated to an increased risk of acute ischemic stroke compared to those with lower PACs frequency. In a multivariable-adjusted Cox regression model, frequent PACs were associated with an increased risk of acute ischemic stroke (adjusted hazard ratio, 2.98; 95% Confidence interval, 1.12-7.92; p-value = 0.028).

Conclusion

Our study demonstrated that non-AF ESKD on RRT patients with frequent PACs presented a higher risk of acute ischemic stroke. Further research is needed to establish the threshold for frequent PACs and to develop prevention strategies for affected individuals.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025p0a8f3yn