Atrial fibrillation in chronic dialysis patients in the United States: risk factors for hospitalization and mortality.
BACKGROUND
The incidence and risk factors for hospitalized atrial fibrillation have not been previously assessed in a national population of dialysis patients.


METHODS
We analyzed the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave II in a historical cohort study of hospitalized atrial fibrillation. Data from 3374 patients who started dialysis in 1996 with valid follow-up times were available for analysis, censored at the time of renal transplantation and followed until November 2000. Cox Regression analysis was used to model factors associated with time to first hospitalization for atrial fibrillation (ICD9 code 427.31x) adjusted for comorbidities, demographic factors, baseline laboratory values, blood pressures, dialysis modality, and cardioprotective medications.


RESULTS
The incidence density of atrial fibrillation was 12.5/1000 person years. Factors associated with atrial fibrillation were older age (> or = 71 years vs. <48 years), extremes (both high and low) of pre-dialysis systolic blood pressure, dialysis modality (hemodialysis vs. peritoneal dialysis), and digoxin use. Baseline use of coumadin was associated with reduced mortality in patients later hospitalized for atrial fibrillation.


CONCLUSIONS
Dialysis patients had a high incidence of atrial fibrillation. This risk was largely segregated among those with established risk factors for atrial fibrillation, and hemodialysis patients. Use of coumadin was associated with improved survival among patients later hospitalized for atrial fibrillation.
Abbott
Kevin C
KC
Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA. kevin.abbott@na.amedd.army.mil
Trespalacios
Fernando C
FC
Taylor
Allen J
AJ
Agodoa
Lawrence Y
LY
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D019338:Polypharmacy; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D013223:Statistics as Topic
D002317:Cardiovascular Agents