학술논문
Implantable Loop Recorder Monitoring and the Incidence of Previously Unrecognized Atrial Fibrillation in Patients on Hemodialysis
Document Type
article
Author
Bruce A. Koplan; Wolfgang C. Winkelmayer; Alexandru I. Costea; Prabir Roy-Chaudhury; James A. Tumlin; Vijay Kher; Don E. Williamson; Saurabh Pokhariyal; David M. Charytan; Don Williamson, MD; Prabir Roy-Chaudhury, MD; James Tumlin, MD; Vijay Kher, MD; Vikranth Reddy, MD; Kowdle Chandrasekhar Prakash, MD; David Charytan, MD MSc; Suresh Chandra Tiwari, MD; Saurabh Pokhariyal, MD; Amber Podoll, MD; Sanjeev Jasuja, MD; G. Leslie Walters, MD; Kraig Wangsnes, MD; Alexandru Costea, MD; Selcuk Tombul, MD; Balbir Singh, MD; Brajesh Mishra, MD; Sachin Yalagudri, MD; Abhijeet Shelke, MD; Calambur Narasimhan, MD; A.M. Karthigesan, MD; Abraham Oomman, MD; K P Pramod Kumar, MD; Bruce Koplan, MD; Upendra Kaul, MD; Tapan Ghose, MD; Ripen Gupta, MD; Arvind Sethi, MD; Nikhil Kumar, MD; Ramesh Hariharan, MD; Rajnish Sardana, MD; Arif Wahab, MD; N.N. Khanna, MD; Mark Smith, MD; Suresh Kamath, MD; Claude Galphin, MD; Puneet Sodhi, MD; Rajsekara Chakravarthy, MD; Subba Rao Budithi, MD; Finnian McCausland, MB, MMSc; Sanjeev Gulati, MD; Munawer Dijoo, MD; Upendra Singh, MD; Salil Jain, MD; Vishal Saxena, MD; Gaurav Sagar, MD; David Charytan, MD, MSc; Rachel Fissell, MD; Robert Foley, MD; Charles A. Herzog, MD; Peter A. McCullough, MD; John D. Rogers, MD; James A. Tumlin, MD; Peter Zimetbaum, MD; Manish Assar, MD; Mark Kremers, MD; Wolfgang C. Winkelmayer, MD, ScD
Source
Kidney International Reports, Vol 7, Iss 2, Pp 189-199 (2022)
Subject
Language
English
ISSN
2468-0249
Abstract
Introduction: Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (KF-HD). We determined both AF incidence and burden in patients with KF-HD using implantable loop recorder (ILR) monitoring. Methods: Patients with KF-HD were enrolled and received an ILR. In 6 monitoring months, the incidence of AF events lasting ≥6 minutes was captured. Demographic, clinical, and dialysis characteristics were collected, and associations with incident AF were estimated using negative binomial regression models and expressed as incidence rate ratios and 95% CIs. Results: We enrolled 66 patients with KF-HD (mean age = 56 years, 70% male); 59 (90%) were without previously diagnosed AF. AF lasting ≥6 minutes was detected in 18 of 59 subjects (31%) without previously diagnosed AF and in 5 of 7 subjects (71%) with a previous AF diagnosis. Among the 23 with detected AF, episodes were present on 16% of patient days. Although 14 of 23 patients (61%) had AF on 2.5 vs. 2.5 mEq/l: incidence rate ratio = 0.62; 95% CI, 0.48–0.80) was associated with lower AF risk whereas higher dialysate bicarbonate concentrations (>35 vs. 35 mEq/l: incidence rate ratio = 3.18; 95% CI, 1.13–8.94) were associated with higher AF risk. Conclusion: New AF was detected in approximately one-third of patients with KF-HD. AF affects a substantial proportion of patient days and may be an underappreciated cause of stroke in KF-HD.