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Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients.
Am J Kidney Dis. 2008 Feb; 51(2):255-62.AJ

Abstract

BACKGROUND

Atrial fibrillation is associated with increased mortality and hospitalization in the general population. Data about mortality, morbidity, and hospitalization in hemodialysis patients with atrial fibrillation are limited.

SETTING & PARTICIPANTS

All patients (n = 476) in 5 dialysis centers in Lombardia, Italy, as of June 2003 were enrolled and followed up until June 2006 (median age, 69 years; median hemodialysis duration, 45.2 months; and median follow-up, 36 months). 127 patients had atrial fibrillation at enrollment.

PREDICTORS & OUTCOME

A Cox model was used to relate: (1) atrial fibrillation, age, hemodialysis therapy duration, and comorbid conditions to all-cause and cardiovascular mortality; (2) angiotensin-converting enzyme (ACE)-inhibitor treatment and comorbid conditions to new onset of atrial fibrillation; and (3) atrial fibrillation and comorbid conditions on hospitalization.

RESULTS

There were 167 deaths (39.5% from cardiovascular disease). In multivariable models, atrial fibrillation was independently associated with increased mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.18 to 2.31). This was more notable for cardiovascular (HR, 2.15; 95% CI, 1.27 to 3.64) than noncardiovascular mortality (HR, 1.39; 95% CI, 0.89 to 2.15). New-onset atrial fibrillation occurred in 35 of 349 individuals (4.1 events/100 person-years); the risk of incident atrial fibrillation was lower in those using ACE-inhibitor therapy (HR, 0.29; 95% CI, 0.10 to 0.82) and higher in those with left ventricular hypertrophy (HR, 2.55; 95% CI, 1.04 to 6.26). There were 539 hospitalizations during 3 years, with 114 hospitalizations in 162 patients with atrial fibrillation and 155 hospitalizations in 314 patients without atrial fibrillation (HR, 1.54; 95% CI, 1.18 to 2.01). Rates of stroke did not significantly differ by atrial fibrillation status (P = 0.4).

LIMITATIONS

Because of the observational nature of this study, results for treatment need confirmation in future trials.

CONCLUSIONS

Atrial fibrillation is associated with greater total and cardiovascular mortality. Patients with atrial fibrillation were hospitalized more frequently than patients without atrial fibrillation. ACE inhibitors may decrease the risk of new-onset atrial fibrillation.

Authors+Show Affiliations

Dipartimento di Medicina Clinica e Prevenzione, Università degli Studi di Milano-Bicocca, Monza, Italy. simonetta.genovesi@unimib.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18215703

Citation

Genovesi, Simonetta, et al. "Atrial Fibrillation and Morbidity and Mortality in a Cohort of Long-term Hemodialysis Patients." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 51, no. 2, 2008, pp. 255-62.
Genovesi S, Vincenti A, Rossi E, et al. Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. Am J Kidney Dis. 2008;51(2):255-62.
Genovesi, S., Vincenti, A., Rossi, E., Pogliani, D., Acquistapace, I., Stella, A., & Valsecchi, M. G. (2008). Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 51(2), 255-62. https://doi.org/10.1053/j.ajkd.2007.10.034
Genovesi S, et al. Atrial Fibrillation and Morbidity and Mortality in a Cohort of Long-term Hemodialysis Patients. Am J Kidney Dis. 2008;51(2):255-62. PubMed PMID: 18215703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. AU - Genovesi,Simonetta, AU - Vincenti,Antonio, AU - Rossi,Emanuela, AU - Pogliani,Daniela, AU - Acquistapace,Irene, AU - Stella,Andrea, AU - Valsecchi,Maria Grazia, PY - 2007/05/28/received PY - 2007/10/15/accepted PY - 2008/1/25/pubmed PY - 2008/2/5/medline PY - 2008/1/25/entrez SP - 255 EP - 62 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 51 IS - 2 N2 - BACKGROUND: Atrial fibrillation is associated with increased mortality and hospitalization in the general population. Data about mortality, morbidity, and hospitalization in hemodialysis patients with atrial fibrillation are limited. SETTING & PARTICIPANTS: All patients (n = 476) in 5 dialysis centers in Lombardia, Italy, as of June 2003 were enrolled and followed up until June 2006 (median age, 69 years; median hemodialysis duration, 45.2 months; and median follow-up, 36 months). 127 patients had atrial fibrillation at enrollment. PREDICTORS & OUTCOME: A Cox model was used to relate: (1) atrial fibrillation, age, hemodialysis therapy duration, and comorbid conditions to all-cause and cardiovascular mortality; (2) angiotensin-converting enzyme (ACE)-inhibitor treatment and comorbid conditions to new onset of atrial fibrillation; and (3) atrial fibrillation and comorbid conditions on hospitalization. RESULTS: There were 167 deaths (39.5% from cardiovascular disease). In multivariable models, atrial fibrillation was independently associated with increased mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.18 to 2.31). This was more notable for cardiovascular (HR, 2.15; 95% CI, 1.27 to 3.64) than noncardiovascular mortality (HR, 1.39; 95% CI, 0.89 to 2.15). New-onset atrial fibrillation occurred in 35 of 349 individuals (4.1 events/100 person-years); the risk of incident atrial fibrillation was lower in those using ACE-inhibitor therapy (HR, 0.29; 95% CI, 0.10 to 0.82) and higher in those with left ventricular hypertrophy (HR, 2.55; 95% CI, 1.04 to 6.26). There were 539 hospitalizations during 3 years, with 114 hospitalizations in 162 patients with atrial fibrillation and 155 hospitalizations in 314 patients without atrial fibrillation (HR, 1.54; 95% CI, 1.18 to 2.01). Rates of stroke did not significantly differ by atrial fibrillation status (P = 0.4). LIMITATIONS: Because of the observational nature of this study, results for treatment need confirmation in future trials. CONCLUSIONS: Atrial fibrillation is associated with greater total and cardiovascular mortality. Patients with atrial fibrillation were hospitalized more frequently than patients without atrial fibrillation. ACE inhibitors may decrease the risk of new-onset atrial fibrillation. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18215703/Atrial_fibrillation_and_morbidity_and_mortality_in_a_cohort_of_long_term_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(07)01448-5 DB - PRIME DP - Unbound Medicine ER -