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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Dialysis Modality, Transplant Characteristics, and Incident Atrial Fibrillation After Kidney Transplant: An
Leonardo Pozo Garcia1, Sai Liu2, Colin R Lenihan2
1Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
Insights
Patients on hemodialysis before a kidney transplant face a higher risk of developing atrial fibrillation (AF) post-transplant compared to those on peritoneal dialysis. Longer dialysis vintage also increases AF risk.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence.
- AF affects a significant portion of patients on dialysis.
- The link between pre-transplant dialysis modality and post-transplant AF is not well-established.
Purpose of the Study:
- To investigate the association between pre-transplant dialysis modality and the incidence of new-onset atrial fibrillation after kidney transplantation.
- To assess the impact of dialysis vintage on post-transplant AF risk.
Main Methods:
- Retrospective cohort study using the United States Renal Data System (USRDS).
- Included 43,621 adult Medicare-insured patients receiving their first kidney transplant (2005-2012) without prior AF diagnosis.
- Multivariable Cox regression analysis was employed to estimate hazard ratios.
Main Results:
- Patients on hemodialysis (84.9%) had a 20% higher risk of developing post-transplant AF compared to those on peritoneal dialysis (15.1%).
- Each additional year of pre-transplant dialysis vintage increased the risk of post-transplant AF by 6%.
- Newly diagnosed AF occurred in 286 patients on peritoneal dialysis and 2,315 on hemodialysis.
Conclusions:
- Pre-transplant hemodialysis is associated with an increased risk of new-onset atrial fibrillation after kidney transplantation compared to peritoneal dialysis.
- Increased dialysis vintage is a significant risk factor for post-transplant AF.
- These findings can inform risk stratification and management strategies for transplant recipients.
Rationale & Objective:
Atrial fibrillation is the most common arrhythmia and is increasing in prevalence. The prevalence of atrial fibrillation is high among patients receiving dialysis, affecting ∼21.3% of the patients receiving hemodialysis and 15.5% of those receiving peritoneal dialysis. The association of previous dialysis modality with incident atrial fibrillation in patients after receiving their first kidney transplant has not been studied.
Study Design:
We used the United States Renal Data System to retrospectively identify adult, Medicare-insured patients who received their first kidney transplant between January 1, 2005, and September 30, 2012 and who had not previously been diagnosed with atrial fibrillation.
Setting & Participants:
The study included 43,621 patients who were aged 18 years older when receiving a first kidney transplant between January 1, 2005, and September 30, 2012 and whose primary payer was Medicare (parts A and B) at the time of transplantation and the 6 months preceding it.
Exposure:
Dialysis modality used before transplant.
Outcome:
Time to incidence of atrial fibrillation up to 3 years posttransplant.
Analytical Approach:
Multivariable Cox regression was used to estimate HRs.
Results:
Of 43,621 patients, 84.9% received hemodialysis and 15.1% received peritoneal dialysis before transplant. The mean ± SD age was 51 ± 13.6 years; 60.8% were male, 55.6% White, and 35.8% Black race. The mean dialysis vintage was 4.3 ± 2.8 years. Newly diagnosed atrial fibrillation after kidney transplant occurred in 286 patients (during 15,363 person-years) who had received peritoneal dialysis and in 2,315 patients (during 83,536 person-years) who had received hemodialysis. After multivariable adjustment, atrial fibrillation was 20% (95% CI, 4%-38%) more likely in those who had been receiving hemodialysis versus peritoneal dialysis, regardless of whether death was considered a competing risk or a censoring event. Each year of pretransplant dialysis vintage increased the risk of posttransplant atrial fibrillation by 6% (95% CI, 3%-9%).
Limitations:
Residual confounding; data from billing claims does not specify the duration of atrial fibrillation or whether it is valvular.
Conclusions:
Pretransplant hemodialysis, as compared with peritoneal dialysis, was associated with higher risk of newly diagnosed atrial fibrillation after a first kidney transplant.
Plain-Language Summary:
New-onset atrial fibrillation (AF) occurs in 7% of kidney transplant recipients in the first 3 years posttransplantation. We conducted this study to determine whether pretransplant dialysis modality was associated with posttransplant AF. We identified 43,621 patients; 84.9% used hemodialysis and 15.1% used peritoneal dialysis pretransplant. Multivariable Cox regression was used to estimate hazard ratios. We found that patients receiving hemodialysis pretransplant were at 20% increased risk of developing posttransplant AF as compared with patients receiving peritoneal dialysis. As our understanding of transplant-specific risk factors for AF increases, we may be able to better risk-stratify transplant patients and develop monitoring and management strategies that can improve outcomes.
