Risk profiles for acute health events after incident atrial fibrillation in patients with end-stage renal disease on hemodialysis

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Abstract
Background: Little is known about the cardiovascular risks of incident atrial fibrillation/flutter (AF) in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Methods: We studied older US patients who newly initiated HD for ESRD (2006–11) and who had not previously been diagnosed with AF, stroke, myocardial infarction (MI) or hip fracture. We used Cox regression with AF as a time-varying covariate, adjusted for socio-demographic characteristics and comorbidities to estimate hazard ratios [HRs (95% confidence intervals)] for the events of ischemic stroke, MI and death. Hip fracture served as a negative control outcome. Results: We identified 85 377 older patients (mean age: 76.5 years) who initiated HD; of these, 14.3% were subsequently diagnosed with AF (14.9% thereof as primary diagnosis) and 49.8% died during follow-up. Incident AF was associated with nine times higher adjusted mortality during the first 30 days [9.2 (8.8–9.6)], 5-fold higher mortality between 31 and 90 days [4.6 (4.3–4.8)] and double the mortality beyond 90 days from first AF diagnosis [2.2 (2.1–2.3)]. Incident AF was similarly associated with higher adjusted risk of ischemic stroke: 2.1 (1.6–2.7) during the first 30 days, 2.5 (2.0–3.0) between 31 and 90 days and 1.5 (1.3–1.7) beyond 90 days. Similar findings were obtained for MI. However, the risk of hip fracture was only marginally increased following AF diagnosis [≤30 days: 1.1 (0.7–1.6); 31–90 days: 1.4 (1.0–1.8); >90 days: 1.2 (1.1–1.4)]. All associations were attenuated and the association with hip fracture was null when incident AF was defined by a primary diagnosis code. Conclusions: AF was strongly associated with increased risks of ischemic stroke, MI and death, with risks highest soon after AF diagnosis but extending beyond 90 days.
Funding Information
  • National Institute of Diabetes, Digestive, and Kidney Diseases
  • NIDDK (R01DK095024, K23DK095914, K23DK088865, R01DK103612)
  • Nephrology at Baylor College of Medicine

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