Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study
Abstract Background Patients with end-stage kidney disease on haemodialysis suffer from frequent complications requiring hospitalisation. Atrial fibrillation is a burdensome comorbidity amongst patients on haemodialysis. We aimed to assess frequency, reasons, and duration of hospitalisations in haem...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | Thrombosis Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12959-022-00434-7 |
| _version_ | 1811315029901836288 |
|---|---|
| author | Daniel Steiner Sabine Schmaldienst Matthias Lorenz Renate Klauser-Braun Ingrid Pabinger Cihan Ay Marcus Säemann Oliver Königsbrügge |
| author_facet | Daniel Steiner Sabine Schmaldienst Matthias Lorenz Renate Klauser-Braun Ingrid Pabinger Cihan Ay Marcus Säemann Oliver Königsbrügge |
| author_sort | Daniel Steiner |
| collection | DOAJ |
| description | Abstract Background Patients with end-stage kidney disease on haemodialysis suffer from frequent complications requiring hospitalisation. Atrial fibrillation is a burdensome comorbidity amongst patients on haemodialysis. We aimed to assess frequency, reasons, and duration of hospitalisations in haemodialysis patients and their association with atrial fibrillation and anticoagulation. Methods Prevalent patients with end-stage kidney disease on haemodialysis were recruited into a prospective cohort study and observed for a median observation time of 3.4 years. Hospitalisations were recorded from discharge letters, medical records, and patient interviews. The association of atrial fibrillation, anticoagulation, and time-in-therapeutic range of vitamin K antagonist treatment with hospitalisations was analysed using negative binomial regression. Results Out of 625 patients, 238 (38.1%) had atrial fibrillation. Median number of hospitalisations per patient was 3.0 (1.0–5.0). Incidence rate of hospitalisation was 1.7 per patient-year in all and 1.9 in atrial fibrillation patients, median duration per hospitalisation was 7.9 (4.8–12.9) and 8.8 (5.7–13.3) days, respectively. Most frequent reasons for hospitalisation were vascular access complication/intervention (11.7%) and infection/fever (11.4%), while bleeding events comprised 6.0% of all hospitalisations. Atrial fibrillation patients had 27% higher risk of hospitalisation than patients without atrial fibrillation (incidence rate ratio [IRR] 1.27, 95% confidence interval [CI] 1.10–1.47). In atrial fibrillation patients, anticoagulation (enoxaparin or phenprocoumon, 41.6% of AF patients) was associated with increased risk of all-cause (IRR 1.38, 95%CI 1.14–1.69) and bleeding-related hospitalisation (IRR 1.96, 95%CI 1.06–3.63). There was no association between anticoagulation and stroke-related hospitalisation. In atrial fibrillation patients on phenprocoumon, increasing time-in-therapeutic range was associated with decreased risk of all-cause (IRR 0.35, 95%CI 0.14–0.87), but not bleeding-related hospitalisation (IRR 0.13, 95%CI 0.01–1.38). Conclusion In haemodialysis patients, presence of atrial fibrillation and, among those with atrial fibrillation, anticoagulation were associated with higher risk of all-cause hospitalisation, including bleeding-related hospitalisation in the latter. Increasing time-in-therapeutic range in patients on vitamin K antagonist treatment was associated with decreased risk of all-cause, but not bleeding-related hospitalisation. |
| first_indexed | 2024-04-13T11:22:57Z |
| format | Article |
| id | doaj.art-56a1ae851382422e8ae5c2fe7a2ba1e7 |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-04-13T11:22:57Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-56a1ae851382422e8ae5c2fe7a2ba1e72022-12-22T02:48:46ZengBMCThrombosis Journal1477-95602022-11-0120111010.1186/s12959-022-00434-7Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort studyDaniel Steiner0Sabine Schmaldienst1Matthias Lorenz2Renate Klauser-Braun3Ingrid Pabinger4Cihan Ay5Marcus Säemann6Oliver Königsbrügge7Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of ViennaDepartment of Medicine I, Clinic FavoritenVienna Dialysis CentreDepartment of Medicine III, Clinic DonaustadtClinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of ViennaClinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of ViennaDepartment of Medicine VI, Clinic OttakringClinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of ViennaAbstract Background Patients with end-stage kidney disease on haemodialysis suffer from frequent complications requiring hospitalisation. Atrial fibrillation is a burdensome comorbidity amongst patients on haemodialysis. We aimed to assess frequency, reasons, and duration of hospitalisations in haemodialysis patients and their association with atrial fibrillation and anticoagulation. Methods Prevalent patients with end-stage kidney disease on haemodialysis were recruited into a prospective cohort study and observed for a median observation time of 3.4 years. Hospitalisations were recorded from discharge letters, medical records, and patient interviews. The association of atrial fibrillation, anticoagulation, and time-in-therapeutic range of vitamin K antagonist treatment with hospitalisations was analysed using negative binomial regression. Results Out of 625 patients, 238 (38.1%) had atrial fibrillation. Median number of hospitalisations per patient was 3.0 (1.0–5.0). Incidence rate of hospitalisation was 1.7 per patient-year in all and 1.9 in atrial fibrillation patients, median duration per hospitalisation was 7.9 (4.8–12.9) and 8.8 (5.7–13.3) days, respectively. Most frequent reasons for hospitalisation were vascular access complication/intervention (11.7%) and infection/fever (11.4%), while bleeding events comprised 6.0% of all hospitalisations. Atrial fibrillation patients had 27% higher risk of hospitalisation than patients without atrial fibrillation (incidence rate ratio [IRR] 1.27, 95% confidence interval [CI] 1.10–1.47). In atrial fibrillation patients, anticoagulation (enoxaparin or phenprocoumon, 41.6% of AF patients) was associated with increased risk of all-cause (IRR 1.38, 95%CI 1.14–1.69) and bleeding-related hospitalisation (IRR 1.96, 95%CI 1.06–3.63). There was no association between anticoagulation and stroke-related hospitalisation. In atrial fibrillation patients on phenprocoumon, increasing time-in-therapeutic range was associated with decreased risk of all-cause (IRR 0.35, 95%CI 0.14–0.87), but not bleeding-related hospitalisation (IRR 0.13, 95%CI 0.01–1.38). Conclusion In haemodialysis patients, presence of atrial fibrillation and, among those with atrial fibrillation, anticoagulation were associated with higher risk of all-cause hospitalisation, including bleeding-related hospitalisation in the latter. Increasing time-in-therapeutic range in patients on vitamin K antagonist treatment was associated with decreased risk of all-cause, but not bleeding-related hospitalisation.https://doi.org/10.1186/s12959-022-00434-7HaemodialysisAtrial fibrillationAnticoagulationEnd-stage kidney diseaseHospitalisation |
| spellingShingle | Daniel Steiner Sabine Schmaldienst Matthias Lorenz Renate Klauser-Braun Ingrid Pabinger Cihan Ay Marcus Säemann Oliver Königsbrügge Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study Thrombosis Journal Haemodialysis Atrial fibrillation Anticoagulation End-stage kidney disease Hospitalisation |
| title | Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study |
| title_full | Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study |
| title_fullStr | Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study |
| title_full_unstemmed | Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study |
| title_short | Atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end-stage kidney disease on haemodialysis: a prospective population-based cohort study |
| title_sort | atrial fibrillation and anticoagulation are associated with hospitalisations in patients with end stage kidney disease on haemodialysis a prospective population based cohort study |
| topic | Haemodialysis Atrial fibrillation Anticoagulation End-stage kidney disease Hospitalisation |
| url | https://doi.org/10.1186/s12959-022-00434-7 |
| work_keys_str_mv | AT danielsteiner atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT sabineschmaldienst atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT matthiaslorenz atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT renateklauserbraun atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT ingridpabinger atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT cihanay atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT marcussaemann atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy AT oliverkonigsbrugge atrialfibrillationandanticoagulationareassociatedwithhospitalisationsinpatientswithendstagekidneydiseaseonhaemodialysisaprospectivepopulationbasedcohortstudy |