Atrial Fibrillation Risk After a Kidney Transplant Varies by Dialysis Modality

Likelihood of the arrhythmia is higher with HD compared with PD

BY JODY A. CHARNOW

HEMODIALYSIS (HD) vs peritoneal dialysis (PD) prior to a first kidney transplant is associated with a higher risk for newly diagnosed atrial fibrillation, investigators reported at the 2023 American Transplant Congress in San Diego, California.

Risk Increased by 18%

Patients who had been on HD had a significant 18% increased risk for atrial fibrillation compared with those who had been on PD, after adjusting for multiple variables, Leonardo Pozo Garcia, MD, of Baylor College of Medicine in Houston, and colleagues reported.

Using data from the US Renal Data System, United Network for Organ Sharing, and Medicare parts A and B, Dr Pozo Garcia’s team studied 43,621 adult patients undergoing their first kidney transplant and who did not have previously diagnosed atrial fibrillation. Prior to transplantation, 37,055 patients received HD and 6566 received PD. Patients had a mean age of 51 years. The investigators identified other risk factors for posttransplant atrial fibrillation. Graft failure and receiving a kidney from a female vs male donor were significantly associated with a 2.8fold and 1.1-fold increased cause-specific risk for atrial fibrillation, respectively. Receiving a kidney from a living donor was significantly associated with a 25%

Study identifies transplant factors that increase atrial fibrillation risk.

lower cause-specific risk. A 4-6 vs 0 mismatch was significantly associated with a 26% increased cause-specific risk. In addition, each 1 year on dialysis was significantly associated with a 5% increased cause-specific risk for atrial fibrillation.

Implications for Risk Stratification

“In our study, we found that patients on hemodialysis prior to transplantation were at increased risk of developing new-onset post-kidney transplant atrial fibrillation as compared to patients