Adults receiving hemodialysis at higher risk of developing AF versus peritoneal dialysis

Atrial fibrillation is the most common arrhythmia and is increasing in prevalence. Patients with kidney failure receiving dialysis are at particularly high rise of AF; affecting 15.5% of those receiving peritoneal dialysis and 21.3% of patients receiving hemodialysis. The association of prior dialysis modality with incident AF in patients after receiving their first kidney transplant has not been studied. Therefore, Leonardo Pozo Garcia, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, and colleagues aimed to determine whether pre-transplant dialysis modality, specifically hemodialysis [vs.] peritoneal dialysis, was associated with the risk of post-transplant atrial fibrillation.”

The investigators used information from the United States Renal Data System (USRDS) to examine 43,621 adult Medicare-insured patients who received their first kidney transplant between 2005 and 2012, and who had not previously had AF diagnosis.

The primary exposure for the retrospective analysis was dialysis modality before transplant, while the main outcome was time to incidence of atrial fibrillation within 3 years post-transplant.

The study led to the following findings:

· Of 43,621 patients, 84.9% received hemodialysis and 15.1% received peritoneal dialysis before transplant. The mean dialysis ‘vintage’ was 4.3 yrs.

· Atrial fibrillation occurred in 286 patients who received peritoneal dialysis over 15,363 person-years and 2315 patients who received hemodialysis over 83,536 person-years before kidney transplant.

· After multivariable adjustment, atrial fibrillation was 20% more likely in those who had been receiving hemodialysis vs. peritoneal dialysis, regardless of whether death was considered a competing risk or a censoring event.

· Each year of pre-transplant dialysis vintage increased the risk of post-transplant atrial fibrillation by 6%.

The researchers also highlighted other factors associated with developing post-transplant AF, such as a previous solid organ transplant, human leukocyte antigen mismatch or female donor.

"We found that patients receiving hemodialysis before transplantation were at greater risk of developing new-onset post-kidney transplant AF versus patients who were receiving peritoneal dialysis," the researchers wrote.

"The presence of classic AF risk factors in the recipient plays a critical role but identification of and knowledge about transplant-related factors is important."

"With the increase in our understanding of transplant-specific risk factors for AF, we may be able to better risk-stratify the kidney transplant population and develop management and monitoring strategies that can improve outcomes," they concluded.

Reference:

Garcia LP, et al. Kidney Med. 2023;doi.org/10.1016/j.xkme.2023.100741.