New-onset Afib tied to mortality risk in advanced kidney disease

  • Hung TW & al.
  • PLoS One
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • New-onset Afib (NAF) is associated with a significant increase in mortality risk among patients with advanced chronic kidney disease (CKD).
  • Dialysis confers a significant survival benefit and should be considered standard of care in patients with NAF and CKD.

Why this matters

  • CKD is associated with an increased prevalence of NAF.

Study design

  • Nested case-control study of 3673 dialysis patients aged ≥20 years, matched 1:2 with nondialysis control individuals by sex, age, CKD duration, and index date.
  • 2000-2013 data were obtained from the Taiwanese National Health Insurance Program.
  • Median follow-up ranged from 22 (dialysis+NAF) to 53 (nondialysis, non-NAF) months.
  • Funding: None.

Key results

  • Crude mortality rates (per 1000 person-months; 95% CIs):
    • Nondialysis, non-NAF (n=7034): 3.31 (3.14-3.49).
    • Nondialysis+NAF (n=312): 10.98 (9.32-12.95).
    • Dialysis, non-NAF (n=3426): 9.19 (8.73-9.66).
    • Dialysis+NAF (n=247): 18.04 (15.38-21.16).
  • Using nondialysis, non-NAF patients as a reference, mortality risk was higher (all P<.0001 with: style="list-style-type:circle;">
  • Nondialysis+NAF: aHR, 1.968.
  • Dialysis, non-NAF: aHR, 2.709.
  • Dialysis+NAF: aHR, 3.466.
  • Stratified mortality risk with NAF vs non-NAF was significantly higher (P=.0005) in nondialysis patients (aHR, 1.838; P<.0001 vs dialysis patients>

    Limitations

    • Specific cause of death was not captured.
    • Retrospective, observational design.