Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis
Background: Atrial fibrillation (AF) is common in patients with end-stage kidney disease (ESKD) on dialysis. Whether pre-ESKD nephrology care associates with AF is uncertain. Methods: We conducted a retrospective cohort study of older US patients (≥67 years) with Medicare A&B who initiated dialy...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-05-01
|
| Series: | Kidney International Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024919300506 |
| _version_ | 1818987320165007360 |
|---|---|
| author | Samaya Anumudu Medha Airy Kevin F. Erickson Sankar D. Navaneethan Tara I. Chang Wolfgang C. Winkelmayer Jingbo Niu |
| author_facet | Samaya Anumudu Medha Airy Kevin F. Erickson Sankar D. Navaneethan Tara I. Chang Wolfgang C. Winkelmayer Jingbo Niu |
| author_sort | Samaya Anumudu |
| collection | DOAJ |
| description | Background: Atrial fibrillation (AF) is common in patients with end-stage kidney disease (ESKD) on dialysis. Whether pre-ESKD nephrology care associates with AF is uncertain. Methods: We conducted a retrospective cohort study of older US patients (≥67 years) with Medicare A&B who initiated dialysis (1996–2013) without a prior diagnosis of AF. Patients were categorized by the duration and number of predialysis nephrology outpatient visits. Patients were followed for 1 year for a new diagnosis of AF. We used multivariable Cox proportional hazards regression while accounting for the competing risks of kidney transplantation and death. Results: We identified 316,067 patients with ESKD initiating dialysis between 1996 and 2013 who had no prior AF diagnosis. In this cohort, 66.9% had any pre-ESKD outpatient nephrology care, with the first outpatient nephrology visit before dialysis initiation occurring at ≤6 months in 17.9%, 7 to 12 months in 9.4%, and >12 months in 39.6%. Outpatient pre-ESKD nephrology care for ≤6, 7 to 12, and >12 months versus none yielded adjusted cause-specific hazard ratios (HRs) of 0.87 (95% CI: 0.84–0.89), 0.83 (95% CI: 0.81–0.86), and 0.85 (95% CI: 0.83–0.87) for incident AF, respectively. Further, having 1 to 4 pre-ESKD outpatient nephrology visits, 5 to 9 visits, and ≥10 visits versus none yielded adjusted cause-specific HRs of 0.89 (95% CI: 0.86–0.91), 0.86 (95% CI: 0.83–0.88), and 0.81 (95% CI: 0.79–0.83), respectively. Conclusions: Having any predialysis nephrology care before initiation of dialysis was associated with slightly lower adjusted rates of incident AF over the first year of dialysis. The optimal timing and intensity of nephrology care to reduce the incidence of AF and other adverse health events requires further study. Keywords: arrhythmia, ESRD, hemodialysis, outcomes, peritoneal dialysis |
| first_indexed | 2024-12-20T19:04:49Z |
| format | Article |
| id | doaj.art-aa7a9ebbcd3e44dab734ef77e859015f |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-20T19:04:49Z |
| publishDate | 2019-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-aa7a9ebbcd3e44dab734ef77e859015f2022-12-21T19:29:18ZengElsevierKidney International Reports2468-02492019-05-0145679687Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating DialysisSamaya Anumudu0Medha Airy1Kevin F. Erickson2Sankar D. Navaneethan3Tara I. Chang4Wolfgang C. Winkelmayer5Jingbo Niu6Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USASection of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USASection of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USASection of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USADivision of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USASection of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Correspondence: Wolfgang C. Winkelmayer, Section of Nephrology, Baylor College of Medicine, One Baylor Plaza, Suite ABBR R705, MS: 395; Houston, Texas 77030, USA.Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USABackground: Atrial fibrillation (AF) is common in patients with end-stage kidney disease (ESKD) on dialysis. Whether pre-ESKD nephrology care associates with AF is uncertain. Methods: We conducted a retrospective cohort study of older US patients (≥67 years) with Medicare A&B who initiated dialysis (1996–2013) without a prior diagnosis of AF. Patients were categorized by the duration and number of predialysis nephrology outpatient visits. Patients were followed for 1 year for a new diagnosis of AF. We used multivariable Cox proportional hazards regression while accounting for the competing risks of kidney transplantation and death. Results: We identified 316,067 patients with ESKD initiating dialysis between 1996 and 2013 who had no prior AF diagnosis. In this cohort, 66.9% had any pre-ESKD outpatient nephrology care, with the first outpatient nephrology visit before dialysis initiation occurring at ≤6 months in 17.9%, 7 to 12 months in 9.4%, and >12 months in 39.6%. Outpatient pre-ESKD nephrology care for ≤6, 7 to 12, and >12 months versus none yielded adjusted cause-specific hazard ratios (HRs) of 0.87 (95% CI: 0.84–0.89), 0.83 (95% CI: 0.81–0.86), and 0.85 (95% CI: 0.83–0.87) for incident AF, respectively. Further, having 1 to 4 pre-ESKD outpatient nephrology visits, 5 to 9 visits, and ≥10 visits versus none yielded adjusted cause-specific HRs of 0.89 (95% CI: 0.86–0.91), 0.86 (95% CI: 0.83–0.88), and 0.81 (95% CI: 0.79–0.83), respectively. Conclusions: Having any predialysis nephrology care before initiation of dialysis was associated with slightly lower adjusted rates of incident AF over the first year of dialysis. The optimal timing and intensity of nephrology care to reduce the incidence of AF and other adverse health events requires further study. Keywords: arrhythmia, ESRD, hemodialysis, outcomes, peritoneal dialysishttp://www.sciencedirect.com/science/article/pii/S2468024919300506 |
| spellingShingle | Samaya Anumudu Medha Airy Kevin F. Erickson Sankar D. Navaneethan Tara I. Chang Wolfgang C. Winkelmayer Jingbo Niu Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis Kidney International Reports |
| title | Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis |
| title_full | Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis |
| title_fullStr | Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis |
| title_full_unstemmed | Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis |
| title_short | Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis |
| title_sort | predialysis nephrology care and incident atrial fibrillation in older patients with eskd initiating dialysis |
| url | http://www.sciencedirect.com/science/article/pii/S2468024919300506 |
| work_keys_str_mv | AT samayaanumudu predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis AT medhaairy predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis AT kevinferickson predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis AT sankardnavaneethan predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis AT taraichang predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis AT wolfgangcwinkelmayer predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis AT jingboniu predialysisnephrologycareandincidentatrialfibrillationinolderpatientswitheskdinitiatingdialysis |