Cargando…
The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis
BACKGROUND: Atrial fibrillation (AF) is highly prevalent, occurring in 1%–2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, su...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992232/ https://www.ncbi.nlm.nih.gov/pubmed/31999778 http://dx.doi.org/10.1371/journal.pone.0228405 |
_version_ | 1783492803426254848 |
---|---|
author | Hsieh, Hui-ling Hsu, Shih-chang Cheng, Ho-shun Chen, Chun-you Huang, Wen-cheng Sue, Yuh-mou Lin, Feng-yen Shih, Chun-ming Chen, Jaw-wen Lin, Shing-jong Huang, Po-hsun Liu, Chung-te |
author_facet | Hsieh, Hui-ling Hsu, Shih-chang Cheng, Ho-shun Chen, Chun-you Huang, Wen-cheng Sue, Yuh-mou Lin, Feng-yen Shih, Chun-ming Chen, Jaw-wen Lin, Shing-jong Huang, Po-hsun Liu, Chung-te |
author_sort | Hsieh, Hui-ling |
collection | PubMed |
description | BACKGROUND: Atrial fibrillation (AF) is highly prevalent, occurring in 1%–2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, suggesting that AF is a possible risk factor for mortality of ESRD patients. However, whether the existence of AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients remains to be defined. METHODS: This retrospective cohort study was performed at Wanfang Hospital from January 2004 to May 2018. The end points were mortality of patients or the end of the study. Incident ESRD patients who were on maintenance hemodialysis for more than 3 months were eligible for inclusion. Cox proportional regression and Kaplan–Meier survival curves were used to determine the association between predictors and mortality. The association between AF and echocardiographic parameters, causes of death were also investigated. RESULTS: Of the 393 incident ESRD patients at initiation of hemodialysis, 57 (14.5%) had AF and the median age was 71 years. Patients with AF were significantly older; showed significantly higher C-reactive protein levels, more heart failure, chronic obstructive pulmonary disease and mortality. Multivariate Cox regression showed that AF had a hazard ratio of 4.1 (95% confidence interval: 2.4–7.0) for mortality. Age-specific analysis showed that AF was significantly associated with mortality in all age groups. Echocardiography measurements including ejection fraction and left ventricular hypertrophy (LVH) were similar in AF and non-AF patients. Cause-specific analysis showed that AF significantly associated with overall cardiovascular death and death due to acute myocardial infarction/coronary artery disease and sepsis. CONCLUSIONS: AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients regardless of age. The systolic function and degree of LVH were similar in AF and non-AF patients. The association between AF and sepsis-related death suggested the role of systemic inflammation on the pathogenesis of AF. |
format | Online Article Text |
id | pubmed-6992232 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-69922322020-02-20 The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis Hsieh, Hui-ling Hsu, Shih-chang Cheng, Ho-shun Chen, Chun-you Huang, Wen-cheng Sue, Yuh-mou Lin, Feng-yen Shih, Chun-ming Chen, Jaw-wen Lin, Shing-jong Huang, Po-hsun Liu, Chung-te PLoS One Research Article BACKGROUND: Atrial fibrillation (AF) is highly prevalent, occurring in 1%–2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, suggesting that AF is a possible risk factor for mortality of ESRD patients. However, whether the existence of AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients remains to be defined. METHODS: This retrospective cohort study was performed at Wanfang Hospital from January 2004 to May 2018. The end points were mortality of patients or the end of the study. Incident ESRD patients who were on maintenance hemodialysis for more than 3 months were eligible for inclusion. Cox proportional regression and Kaplan–Meier survival curves were used to determine the association between predictors and mortality. The association between AF and echocardiographic parameters, causes of death were also investigated. RESULTS: Of the 393 incident ESRD patients at initiation of hemodialysis, 57 (14.5%) had AF and the median age was 71 years. Patients with AF were significantly older; showed significantly higher C-reactive protein levels, more heart failure, chronic obstructive pulmonary disease and mortality. Multivariate Cox regression showed that AF had a hazard ratio of 4.1 (95% confidence interval: 2.4–7.0) for mortality. Age-specific analysis showed that AF was significantly associated with mortality in all age groups. Echocardiography measurements including ejection fraction and left ventricular hypertrophy (LVH) were similar in AF and non-AF patients. Cause-specific analysis showed that AF significantly associated with overall cardiovascular death and death due to acute myocardial infarction/coronary artery disease and sepsis. CONCLUSIONS: AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients regardless of age. The systolic function and degree of LVH were similar in AF and non-AF patients. The association between AF and sepsis-related death suggested the role of systemic inflammation on the pathogenesis of AF. Public Library of Science 2020-01-30 /pmc/articles/PMC6992232/ /pubmed/31999778 http://dx.doi.org/10.1371/journal.pone.0228405 Text en © 2020 Hsieh et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Hsieh, Hui-ling Hsu, Shih-chang Cheng, Ho-shun Chen, Chun-you Huang, Wen-cheng Sue, Yuh-mou Lin, Feng-yen Shih, Chun-ming Chen, Jaw-wen Lin, Shing-jong Huang, Po-hsun Liu, Chung-te The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis |
title | The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis |
title_full | The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis |
title_fullStr | The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis |
title_full_unstemmed | The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis |
title_short | The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis |
title_sort | influence of atrial fibrillation on the mortality of incident esrd patients undergoing maintenance hemodialysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992232/ https://www.ncbi.nlm.nih.gov/pubmed/31999778 http://dx.doi.org/10.1371/journal.pone.0228405 |
work_keys_str_mv | AT hsiehhuiling theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT hsushihchang theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT chenghoshun theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT chenchunyou theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT huangwencheng theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT sueyuhmou theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT linfengyen theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT shihchunming theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT chenjawwen theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT linshingjong theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT huangpohsun theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT liuchungte theinfluenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT hsiehhuiling influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT hsushihchang influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT chenghoshun influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT chenchunyou influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT huangwencheng influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT sueyuhmou influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT linfengyen influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT shihchunming influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT chenjawwen influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT linshingjong influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT huangpohsun influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis AT liuchungte influenceofatrialfibrillationonthemortalityofincidentesrdpatientsundergoingmaintenancehemodialysis |