Khairallah Pascale, Liu Sai, Montez-Rath Maria E, Erickson Kevin F, Chang Tara I, Winkelmayer Wolfgang C
Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Am J Nephrol. 2025 May 5:1-11. doi: 10.1159/000546266.
Atrial fibrillation (AF) is common in persons with kidney failure on hemodialysis. In the general population, higher intact parathyroid hormone (iPTH) levels were found to be associated with presence of AF. Whether iPTH associates with AF in patients on hemodialysis is unknown.
Using merged USRDS-DaVita data (2006-2011), we selected persons aged 67+ years who initiated hemodialysis and survived 120 days. Eligible persons had continuous Medicare A + B coverage from 2 years prior to kidney failure and no diagnosis of AF. Sociodemographic, comorbidity, and clinical information were abstracted from Medicare forms, billing claims, and electronic health records. iPTH was categorized consistent with previous work: <150; 150 to <300; 300 to <600; and ≥600 pg/mL. Patients were followed for incident (i.e., newly diagnosed) AF as reflected in inpatient and outpatient claims. Unadjusted and multivariable Cox regression were used to estimate the associations of time-updated iPTH category (referent: 150 to <300 pg/mL) with incident AF.
Of 15,225 patients initiating hemodialysis, surviving 120 days, and without a prior diagnosis of AF, iPTH (in pg/mL) at baseline was <150 in 4,479, 150 to <300 in 5,964, 300 to <600 in 3,479, and ≥600 in 1,064 persons. During 21,845 patient-years, 2,857 patients had incident AF (rate, 13.1/100 person-years). After multivariable adjustment, patients with iPTH <150 pg/mL had 13% (95% confidence interval [CI]: 3-25%) higher relative AF incidence compared with the 150 to <300 pg/mL group, but no association was found for those with iPTH 300 to <600 (hazard ratio [HR]: 1.04; 95% CI: 0.95-1.14) or iPTH ≥600 pg/mL (HR: 0.90; 95% CI: 0.75-1.08).
Among persons with incident kidney failure on hemodialysis, compared with those whose iPTH was between 150 and <300 pg/mL, lower iPTH was independently associated with higher AF incidence; however, no association with AF was identified for higher iPTH levels.
心房颤动（AF）在接受血液透析的肾衰竭患者中很常见。在普通人群中，较高的全段甲状旁腺激素（iPTH）水平与AF的存在有关。在接受血液透析的患者中，iPTH是否与AF相关尚不清楚。
利用合并的美国肾脏数据系统（USRDS）-达维塔（DaVita）数据（2006 - 2011年），我们选择了67岁及以上开始接受血液透析且存活120天的患者。符合条件的患者在肾衰竭前两年连续享有医疗保险A + B福利，且未被诊断为AF。社会人口统计学、合并症和临床信息从医疗保险表格、计费索赔和电子健康记录中提取。iPTH按照先前的研究进行分类：<150；150至<300；300至<600；以及≥600 pg/mL。根据住院和门诊索赔情况对患者进行随访，以确定新发（即新诊断）AF。使用未调整和多变量Cox回归来估计随时间更新的iPTH类别（参照：150至<300 pg/mL）与新发AF之间的关联。
在15225例开始接受血液透析、存活120天且先前未诊断为AF的患者中，基线时iPTH（单位：pg/mL）<150的有4479人，150至<300的有5964人，300至<600的有3479人，≥600的有1064人。在21845患者年期间，2857例患者发生新发AF（发生率为13.1/100人年）。多变量调整后，iPTH<150 pg/mL的患者与150至<300 pg/mL组相比，AF相对发生率高13%（95%置信区间[CI]：3 - 25%），但iPTH为300至<600（风险比[HR]：1.04；95% CI：0.95 - 1.
