Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan City, 333, Taiwan.
J Nephrol. 2021 Feb;34(1):53-62. doi: 10.1007/s40620-020-00713-4. Epub 2020 Feb 21.
Patients with end-stage renal disease (ESRD) undergoing dialysis have increased risks of atrial fibrillation (AF).
To investigate dialysis-related incident AF and associated outcomes.
Patients with dialysis were retrieved using data from Taiwan National Health Insurance Research Database during 2001-2013. Patients were separated into peritoneal dialysis (PD) and hemodialysis (HD) according to their initial modality. Primary outcome was new-onset AF. Secondary outcomes were AF-associated ischemic stroke (IS)/systemic embolism (SE) and hemorrhagic stroke.
A total of 158,910 dialytic patients were retrieved. After exclusion criteria, a total of 117,023 patients with ESRD undergoing dialysis were separated into 12,659 patients on PD and 104,364 patients on HD. There were 458 PD patients with subsequent development of AF, and 6216 HD patients with subsequent development of AF. At end of follow-up, patients on PD and HD had AF incidence densities of 7.8 and 8.8 events per 1000 person-years, the SHR of PD versus HD was 0.83 (95% CI 0.73-0.94). The SHR of PD versus HD was 1.07 (95% CI 0.80-1.44) for IS/SE and the SHR of PD versus HD was 0.34 (95% CI 0.13-0.90) for hemorrhagic stroke.
In patients with ESRD undergoing dialysis, PD had lowered risks of new onset of AF compared to HD. Subsequently, these AF patients in PD group had comparable incidence of ischemic stroke but decreased incidence of hemorrhagic stroke compared to AF patients in HD group. PD could be the most suitable modality in patients at risk for the onset of AF.
接受透析治疗的终末期肾病（ESRD）患者发生心房颤动（AF）的风险增加。
研究与透析相关的首发 AF 及相关结局。
使用 2001 年至 2013 年台湾全民健康保险研究数据库中的数据检索接受透析治疗的患者。根据初始治疗方式将患者分为腹膜透析（PD）和血液透析（HD）组。主要结局为新发 AF。次要结局为 AF 相关的缺血性脑卒中（IS）/系统性栓塞（SE）和出血性脑卒中。
共纳入 158910 例透析患者。排除标准后，共纳入 117023 例 ESRD 透析患者，其中 PD 组 12659 例，HD 组 104364 例。458 例 PD 患者出现后续 AF，6216 例 HD 患者出现后续 AF。随访结束时，PD 和 HD 患者的 AF 发生率密度分别为 7.8 和 8.8 事件/1000 人年，PD 与 HD 的 SHR 为 0.83（95%CI 0.73-0.94）。PD 与 HD 的 SHR 为 1.07（95%CI 0.80-1.44）用于 IS/SE，PD 与 HD 的 SHR 为 0.34（95%CI 0.13-0.90）用于出血性脑卒中。
在接受透析治疗的 ESRD 患者中，与 HD 相比，PD 发生新发 AF 的风险降低。随后，与 HD 组的 AF 患者相比，PD 组的 AF 患者发生缺血性脑卒中的发生率相当，但发生出血性脑卒中的发生率降低。对于有 AF 发病风险的患者，PD 可能是最合适的治疗方式。
