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Atrial fibrillation and risk of stroke in dialysis patients

James B Wetmore1, Edward F Ellerbeck, Jonathan D Mahnken

  • 1Department of Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, KS, USA. jwetmore@kumc.edu

Annals of Epidemiology
|January 22, 2013
PubMed

Insights

Chronic atrial fibrillation (AF) modestly increases ischemic stroke risk in dialysis patients. Hemorrhagic stroke risk is significantly higher in African Americans, Hispanics, and other non-Caucasian groups.

Area of Science:

  • Nephrology
  • Cardiology
  • Stroke Medicine

Background:

  • Dialysis patients frequently experience stroke and chronic atrial fibrillation (AF).
  • The precise incidence of new strokes and the impact of AF in this population remain unclear.

Purpose of the Study:

  • To investigate the incidence of new strokes in dialysis patients.
  • To determine the association between chronic atrial fibrillation (AF) and stroke risk in this cohort.

Main Methods:

  • Utilized Medicare claims data for dually eligible incident dialysis patients.
  • Chronic AF was treated as a time-dependent covariate.
  • Cox proportional hazards models analyzed time to stroke events.

Main Results:

  • Of 56,734 patients, 9.9% developed chronic AF.
  • Stroke incidence was 22.8 ischemic and 5.0 hemorrhagic per 1000 patient-years.
  • Chronic AF was linked to increased ischemic stroke risk (HR 1.26), but not hemorrhagic stroke. Race/ethnicity strongly predicted hemorrhagic stroke.

Conclusions:

  • Chronic AF shows a significant, albeit modest, association with ischemic stroke in dialysis patients.
  • Race/ethnicity is a strong determinant of hemorrhagic stroke risk.
  • The proportion of hemorrhagic strokes is notably higher in dialysis patients compared to the general population.
Abstract

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