| Research Abstract |
A total of 1510 adult hemodialysis patients who lived in northern part of Iwate prefecture and 26, 469 community-dwelling people who lived in the same area were enrolled. Prevalences of atrial fibrillation(AF) were 3.8% in hemodialysis patients and 1.5% in community dwelling people, respectively. Standardized prevalence ratios(95% confidence intervals) of AF in hemodialysis patients compared to those in community-dwelling people were 2.59(1.91-3.26) in total subjects, 1.80(1.29-2.30) in male subjects and 2.15(0.66-3.63) in female subjects, respectively.
Prospective cohort studies were carried out. There were 3909 person-years(mean 3.9 years) in hemodilaysis patients cohort study(n=1, 009) and 147, 513 person-years(mean 5.6 years) in community-dwelling people cohort study(n=26, 469). Crude mortality rates of all-cause, cardiovascular and infectious disease-related and crude incidence rates of acute myocardioal infarction(AMI) and stroke(AF vs. non-AF) were 279 vs. 88.7、96.5 vs. 43.2、96.5
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vs. 22.9、22.0 vs. 11.3、55.2 vs. 47.3, respectively, in hemodilaysis patients and those were 25.9 vs. 6.84, 12.2 vs. 1.46, 4.70 vs. 0.8, 2.37 vs. 0.59, 28.7 vs. 4.81, respectively, in community-dwelling people.
Sex-and age-adjusted mortality(incidence) rate ratios attributable to AF were estimated by Poisson regression analysis after adjusting for persons aged 60-year old and adjusting for male to female ratio being 1.0.Adjusted mortality rate ratios(95% confidence intervals) of all-cause were 1.76(1.34-2.31) in community-dwelling people, 1.70(1.13-2.65) in hemodialysis patients, respectively. Rate ratios of cardiovascular death were 3.91(2.58-5.91) in community-dwelling people, 1.27(0.64-2.50) in hemodialysis patients, respectively. Rate ratios of infectious disease-related death were 1.89(0.99-3.6) in community-dwelling people, 2.22(1.09-4.50) in hemodialysis patients. Rate ratio of incident stroke was 3.41(2.59-4.51) in community-dwelling people. Increased risks for incident AMI and incident stroke were not observed in hemodialysis patients.
Hemodilayis patients have a two-fold high prevalence of AF compared to that in general population. Persons with AF had a 1.7-fold high risk for all-cause death compared to that in persons without AF both in hemodilysis patients and general population. Significantly elevated risks for cardiovascular death and incident stroke attributable to AF were observed in general population, whilst they were not observed in hemodialysis patients. Less
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