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Atrial Fibrillation in Hemodialysis Patients
Study Questions:
How does new-onset atrial fibrillation (AF) affect outcomes in hemodialysis patients?
Methods:
The data for this retrospective cohort study were obtained from a Taiwanese health insurance research database during 1998-2011. Hemodialysis patients with new-onset AF (n = 6,494, mean age 68.6 years) were identified. A propensity-score matched group of hemodialysis patients without AF (n = 6,494, mean age 68.4 years) served as a control group. The primary outcome was ischemic stroke.
Results:
The mean follow-up was 3.2 years. Compared to the control group, the patients with new-onset AF had higher risks of ischemic stroke (hazard ratio [HR], 1.27), all-cause mortality (HR, 1.59), in-hospital cardiovascular death (HR, 1.83), myocardial infarction (HR, 1.33), and heart failure (HR, 1.9). After adjustment for in-hospital deaths, AF was associated with a higher risk of heart failure (HR, 1.56) and in-hospital cardiovascular death (HR, 1.65), but not stroke or myocardial infarction.
Conclusions:
The authors concluded that new-onset AF is associated with an increased risk of stroke in hemodialysis patients, but not after adjustment for in-hospital deaths.
Perspective:
Hemodialysis patients typically have multiple comorbidities, and AF would be expected to increase the risk of ischemic stroke at least as much as in patients without renal failure. This has in fact been reported to be the case in several prior studies. However, the prior studies were relatively small and did not account for the competing risk of in-hospital death. The results of this study suggest that the risk of death overshadows the risk of stroke in hemodialysis patients with AF, implying that the risk of anticoagulation may be greater than the potential benefit.
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Heart Failure, Mortality, Myocardial Infarction, Renal Dialysis, Renal Insufficiency, Risk, Secondary Prevention, Stroke
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