The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

PLoS One. 2020 Jan 30;15(1):e0228405. doi: 10.1371/journal.pone.0228405. eCollection 2020.

Abstract

Background: Atrial fibrillation (AF) is highly prevalent, occurring in 1%-2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, suggesting that AF is a possible risk factor for mortality of ESRD patients. However, whether the existence of AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients remains to be defined.

Methods: This retrospective cohort study was performed at Wanfang Hospital from January 2004 to May 2018. The end points were mortality of patients or the end of the study. Incident ESRD patients who were on maintenance hemodialysis for more than 3 months were eligible for inclusion. Cox proportional regression and Kaplan-Meier survival curves were used to determine the association between predictors and mortality. The association between AF and echocardiographic parameters, causes of death were also investigated.

Results: Of the 393 incident ESRD patients at initiation of hemodialysis, 57 (14.5%) had AF and the median age was 71 years. Patients with AF were significantly older; showed significantly higher C-reactive protein levels, more heart failure, chronic obstructive pulmonary disease and mortality. Multivariate Cox regression showed that AF had a hazard ratio of 4.1 (95% confidence interval: 2.4-7.0) for mortality. Age-specific analysis showed that AF was significantly associated with mortality in all age groups. Echocardiography measurements including ejection fraction and left ventricular hypertrophy (LVH) were similar in AF and non-AF patients. Cause-specific analysis showed that AF significantly associated with overall cardiovascular death and death due to acute myocardial infarction/coronary artery disease and sepsis.

Conclusions: AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients regardless of age. The systolic function and degree of LVH were similar in AF and non-AF patients. The association between AF and sepsis-related death suggested the role of systemic inflammation on the pathogenesis of AF.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / physiopathology
  • Cause of Death
  • Echocardiography
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging*
  • Hypertrophy, Left Ventricular / mortality
  • Hypertrophy, Left Ventricular / physiopathology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Male
  • Renal Dialysis / methods*
  • Retrospective Studies
  • Stroke Volume
  • Survival Analysis

Grants and funding

This work was supported by the Wan Fang Hospital, Taipei Medical University, 108-wf-swf-05 to C-tL; the Ministry of Science and Technology of Taiwan, MOST 104-2314-B-075-047 to P-hH; the Ministry of Science and Technology of Taiwan, MOST 106-2314-B-350-001-MY3 to P-hH; the Novel Bioengineering and Technological Approaches to Solve Two Major Health Problems in Taiwan program, sponsored by the Taiwan Ministry of Science and Technology Academic Excellence Program, MOST 106-2633-B-009-001 to P-hH; the Ministry of Health and Welfare, MOHW106-TDU-B-211-113001 to P-hH and the Taipei Veterans General Hospital, V105C-0207, V106C-045 to P-hH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.