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Clin J Am Soc Nephrol. 2019 Jun 7. pii: CJN.13511118. doi: 10.2215/CJN.13511118. [Epub ahead of print]

Blood Pressure and Incident Atrial Fibrillation in Older Patients Initiating Hemodialysis.

Author information

1
Divisions of Nephrology and.
2
Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas.
3
Cardiovascular Medicine, Stanford University, Stanford, California.
4
Division of Cardiovascular Medicine, Palo Alto Veterans Affairs Medical Center, Palo Alto, California; and.
5
Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina.
6
Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; Wolfgang.Winkelmayer@bcm.edu.

Abstract

BACKGROUND AND OBJECTIVES:

We examined the association of predialysis systolic and diastolic BP and intradialytic hypotension with incident atrial fibrillation in older patients initiating hemodialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We used the US Renal Data System linked to the records of a large dialysis provider to identify patients aged ≥67 years initiating hemodialysis between January 2006 and October 2011. We examined quarterly average predialysis systolic BP, diastolic BP, and proportion of sessions with intradialytic hypotension (i.e., nadir systolic BP <90 mm Hg). We applied an extended Cox model to compute adjusted hazard ratios (HRs) of each exposure with incident atrial fibrillation.

RESULTS:

Among 17,003 patients, 3785 developed atrial fibrillation. When comparing predialysis systolic BP to a fixed reference of 140 mm Hg, lower predialysis systolic BP was associated with a higher hazard of atrial fibrillation, whereas higher systolic BP was associated with a lower hazard of atrial fibrillation. When comparing across a range of systolic BP for two hypothetical patients with similar measured covariates, the association varied by mean systolic BP: at systolic BP 190 mm Hg, each 10 mm Hg lower systolic BP was associated with lower atrial fibrillation hazard (HR, 0.94; 95% confidence interval, 0.90 to 1.00), whereas at systolic BP 140 mm Hg, a 10 mm Hg lower systolic BP was associated with a higher atrial fibrillation hazard (HR, 1.12; 95% confidence interval, 1.10 to 1.14). Lower diastolic BP was associated with higher atrial fibrillation hazards. Intradialytic hypotension was weakly associated with atrial fibrillation.

CONCLUSIONS:

In this observational study of older patients initiating hemodialysis, lower predialysis systolic BP and diastolic BP were associated with higher incidence of atrial fibrillation.

KEYWORDS:

Atrial Fibrillation; Blood Pressure Determination; Cardiovascular; Diastole; Incidence; Proportional Hazards Model; Systole; blood pressure; hemodialysis; hypotension; renal dialysis

PMID:
31175104
DOI:
10.2215/CJN.13511118

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