Dialysis Modality, Transplant Characteristics, and Incident Atrial Fibrillation After Kidney Transplant: An Observational Study Using USRDS Data

Authors

Leonardo Pozo Garcia
Sai Liu
Colin R Lenihan
Maria E Montez-Rath
Tara I Chang
Wolfgang C Winkelmayer
Pascale Khairallah

Publication Date

1-1-2024

Journal

Kidney Medicine

DOI

10.1016/j.xkme.2023.100741

PMID

38188456

PMCID

PMC10770630

PubMedCentral® Posted Date

10-12-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Transplant, kidney failure, arrhythmia, hemodialysis, peritoneal dialysis, atrial fibrillation

Abstract

RATIONALE & OBJECTIVE: Atrial fibrillation is the most common arrhythmia and is increasing in prevalence. The prevalence of atrial fibrillation is high among patients receiving dialysis, affecting ∼21.3% of the patients receiving hemodialysis and 15.5% of those receiving peritoneal dialysis. The association of previous dialysis modality with incident atrial fibrillation in patients after receiving their first kidney transplant has not been studied.

STUDY DESIGN: We used the United States Renal Data System to retrospectively identify adult, Medicare-insured patients who received their first kidney transplant between January 1, 2005, and September 30, 2012 and who had not previously been diagnosed with atrial fibrillation.

SETTING & PARTICIPANTS: The study included 43,621 patients who were aged 18 years older when receiving a first kidney transplant between January 1, 2005, and September 30, 2012 and whose primary payer was Medicare (parts A and B) at the time of transplantation and the 6 months preceding it.

EXPOSURE: Dialysis modality used before transplant.

OUTCOME: Time to incidence of atrial fibrillation up to 3 years posttransplant.

ANALYTICAL APPROACH: Multivariable Cox regression was used to estimate HRs.

RESULTS: Of 43,621 patients, 84.9% received hemodialysis and 15.1% received peritoneal dialysis before transplant. The mean ± SD age was 51 ± 13.6 years; 60.8% were male, 55.6% White, and 35.8% Black race. The mean dialysis vintage was 4.3 ± 2.8 years. Newly diagnosed atrial fibrillation after kidney transplant occurred in 286 patients (during 15,363 person-years) who had received peritoneal dialysis and in 2,315 patients (during 83,536 person-years) who had received hemodialysis. After multivariable adjustment, atrial fibrillation was 20% (95% CI, 4%-38%) more likely in those who had been receiving hemodialysis versus peritoneal dialysis, regardless of whether death was considered a competing risk or a censoring event. Each year of pretransplant dialysis vintage increased the risk of posttransplant atrial fibrillation by 6% (95% CI, 3%-9%).

LIMITATIONS: Residual confounding; data from billing claims does not specify the duration of atrial fibrillation or whether it is valvular.

CONCLUSIONS: Pretransplant hemodialysis, as compared with peritoneal dialysis, was associated with higher risk of newly diagnosed atrial fibrillation after a first kidney transplant.

PLAIN-LANGUAGE SUMMARY: New-onset atrial fibrillation (AF) occurs in 7% of kidney transplant recipients in the first 3 years posttransplantation. We conducted this study to determine whether pretransplant dialysis modality was associated with posttransplant AF. We identified 43,621 patients; 84.9% used hemodialysis and 15.1% used peritoneal dialysis pretransplant. Multivariable Cox regression was used to estimate hazard ratios. We found that patients receiving hemodialysis pretransplant were at 20% increased risk of developing posttransplant AF as compared with patients receiving peritoneal dialysis. As our understanding of transplant-specific risk factors for AF increases, we may be able to better risk-stratify transplant patients and develop monitoring and management strategies that can improve outcomes.