title: Atrial fibrillation and risk of stroke in dialysis patients.
abstract: OBJECTIVE
  Both stroke and chronic atrial fibrillation (AF) are common in dialysis patients, but uncertainty exists in the incidence of new strokes and the risk conferred by chronic AF.
  
  
  METHODS
  A cohort of dually eligible (Medicare and Medicaid) incident dialysis patients was constructed. Medicare claims were used to determine the onset of chronic AF, which was specifically treated as a time-dependent covariate. Cox proportional hazards models were used to model time to stroke.
  
  
  RESULTS
  Of 56,734 patients studied, 5629 (9.9%) developed chronic AF. There were 22.8 ischemic and 5.0 hemorrhagic strokes per 1000 patient-years, a ratio of approximately 4.5:1. Chronic AF was independently associated with time to ischemic (hazard ratio [HR], 1.26; 99% confidence interval [CI], 1.06-1.49; P = .0005), but not hemorrhagic, stroke. Race was strongly associated with hemorrhagic stroke: African Americans (HR, 1.46; 99% CI, 1.08-1.96), Hispanics (HR, 1.64; 99% CI, 1.16-2.31), and others (HR, 1.76; 99% CI, 1.16-2.78) had higher rates than did Caucasians (all P < .001).
  
  
  CONCLUSIONS
  Chronic AF has a significant, but modest, association with ischemic stroke. Race/ethnicity is strongly associated with hemorrhagic strokes. The proportion of strokes owing to hemorrhage is much higher than in the general population.
authors: Department of Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, KS, USA. jwetmore@kumc.edu
authors: James B
authors: JB
authors: Wetmore
authors: Edward F
authors: EF
authors: Ellerbeck
authors: Jonathan D
authors: JD
authors: Mahnken
authors: Milind
authors: M
authors: Phadnis
authors: Sally K
authors: SK
authors: Rigler
authors: Purna
authors: P
authors: Mukhopadhyay
authors: John A
authors: JA
authors: Spertus
authors: Xinhua
authors: X
authors: Zhou
authors: Qingjiang
authors: Q
authors: Hou
authors: Theresa I
authors: TI
authors: Shireman
mesh_terms: D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015984:Causality; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data