Long-term outcomes of dialysis in patients with chronic kidney disease and new-onset atrial fibrillation: A population-based cohort study


Autoři: Tung-Wei Hung aff001;  Jing-Yang Huang aff002;  Gwo-Ping Jong aff003
Působiště autorů: Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, ROC aff001;  Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC aff002;  Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, ROC aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222656

Souhrn

Background

Chronic kidney disease (CKD) is associated with substantial cardiovascular morbidity. Atrial fibrillation (AF) is a prevalent arrhythmia that increases the risk of both stroke and cardiovascular mortality. Information about the mortality risk among patients with advanced CKD and new-onset AF (NAF) in the presence and absence of dialysis is important. However, the association between advanced CKD and NAF in patients with and without dialysis is unclear.

Objective

To investigate long-term outcomes of the association between advanced CKD and NAF in patients with and without dialysis.

Methods

We conducted a nested case-control study based on the National Health Insurance Program in Taiwan. Each participant aged 20 years and older who had CKD with dialysis from 2000 to 2013 was assigned to the dialysis group, whereas sex-, age-, CKD duration-, and index date-matched participants without dialysis were randomly selected and assigned to the non-dialysis group. We used the Cox regression model to estimate the hazard ratio (HR) with the 95% confidence interval (CI) for mortality in CKD patients with combined dialysis and NAF. Patients with neither NAF nor dialysis served as the reference group.

Results

We identified 3,673 dialysis cases and 7,346 Non-dialysis matched controls for enrolment in the study. The crude mortality rates were 3.3 (95% CI: 3.1–3.5), 10.98 (95% CI: 9.3–13.0), 9.2 (95% CI: 8.7–10.0), and 18.0 (95% CI: 15.4–21.2) in the [Non-dialysis, non-NAF], [Non-dialysis, NAF], [Dialysis, non-NAF], and [Dialysis, NAF] groups, respectively. After adjustment for age, gender, and co-morbidities, the aHRs were 2.0 (95% CI: 1.7–2.3), 2.7 (95% CI: 2.5–2.9), and 3.5 (95% CI: 2.9–4.1) in the [Non-Dialysis, NAF], [Dialysis, non-NAF], and [Dialysis, NAF] groups compared with the [Non-Dialysis, non-NAF] group, respectively. The Kaplan-Meier survival curves showed the highest mortality risk in the [Dialysis, NAF] group among the study groups. Patients with concurrent peritoneal dialysis and AF had the highest mortality risk: aHR = 4.3 (95% CI: 2.3–8.0). However, there was a relatively lower effect of NAF on mortality in patients on dialysis than in patients who were not.

Conclusions

Patients with advanced CKD and NAF had a significantly increased risk of mortality. Dialysis is not risky for patients with concurrent CKD and NAF. Dialysis offers a sufficient survival benefit to be considered as a standard treatment, as indicated by the superior physical status of patients on dialysis.

Klíčová slova:

Medicine and health sciences – Nephrology – Medical dialysis – Chronic kidney disease – Cardiology – Arrhythmia – Atrial fibrillation – Vascular medicine – Coronary heart disease – Pulmonology – Chronic obstructive pulmonary disease – Endocrinology – Endocrine disorders – Metabolic disorders – Neurology – Cerebrovascular diseases – stroke – Ischemic stroke – Biology and life sciences – Population biology – Population metrics – Death rates


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 9
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