Kidney International Reports (Feb 2022)
Implantable Loop Recorder Monitoring and the Incidence of Previously Unrecognized Atrial Fibrillation in Patients on Hemodialysis
- 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
Affiliations
- Bruce A. Koplan
- Cardiology Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
- Wolfgang C. Winkelmayer
- Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA; Correspondence: Wolfgang C. Winkelmayer, Section of Nephrology, Baylor College of Medicine, One Baylor Plaza, MS: 395, Houston, Texas 77030, USA.
- Alexandru I. Costea
- Cardiology Division, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
- Prabir Roy-Chaudhury
- Department of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina, USA; Department of Medicine, WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina, USA
- James A. Tumlin
- Georgia Nephrology Clinical Research Institute, Atlanta, Georgia, USA
- Vijay Kher
- Medanta Kidney & Urology Institute, Medanta, The Medicity, Gurugram, India
- Don E. Williamson
- Southeastern Clinical Research Institute, Augusta, Georgia, USA
- Saurabh Pokhariyal
- Division of Nephrology and Renal Transplantation, Manipal Hospitals, Dwarka, New Delhi, India
- David M. Charytan
- Nephrology Division, NYU Grossman School of Medicine, New York, New York, USA
- 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
- Journal volume & issue
-
Vol. 7,
no. 2
pp. 189 – 199
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.
