Investigation of the Atrial Fibrillation Risk in Hemodialysis Patients: A Population-Based Cohort Study

探討血液透析病人罹患心房顫動的風險：以群體為基礎的世代研究

鄒順生(Shung-Sheng Tsou) ； 邱怡萍(Yi-Ping Chiu) ； 葉睿儒(Jui-Ju Yeh) ； 王淵宏(Yuan-Hung Wang) ； 張祐剛(Yu-Kang Chang) ； 邱淳志(Chun-Chih Chiu)

《童綜合醫學雜誌》 14卷2期 (2020/12) Pp. 69-75

https://doi.org/10.3966/207135922020121402003

摘要

Background and Purpose: Previous studies have reported that hemodialysis (HD) patients generally are at higher risk of cardiovascular diseases; however, the association between HD patients and atrial fibrillation risk is still inconclusive. Therefore, we explored the incidence and risk of atrial fibrillation among hemodialysis patients in Taiwan. Methods: A total of 15,622 HD patients were selected from Taiwan’s National Health Insurance Research Database. A total of 54,243 individuals without chronic kidney disease were randomly selected as controls. A hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the risk of atrial fibrillation using a Cox proportional hazards model. Results: We observed that 6188 controls and 5902 HD patients had new-onset atrial fibrillation. The incidence rate ratio for atrial fibrillation was 2.29 (95% CI 2.13-2.46) and the adjusted HR for atrial fibrillation risk was 1.95 (95% CI 1.76-2.17) in the HD patients. In particular, those HD patients with an older age, diabetes mellitus, hypertension, hyperlipidemia, or ischemic heart disease had a significantly higher risk of atrial fibrillation. Conclusions: Our results revealed that older hemodialysis patients with certain comorbidities had an increased risk of atrial fibrillation. We should pay particular attention to the clinical care of hemodialysis patients with these specific risk factors.

關鍵字

Atrial fibrillation ； Chronic kidney disease ； Hemodialysis ； National Health Insurance Research Database

並列摘要

背景及目的：過去的研究發現血液透析病人會具有較高罹患心血管疾病的風險。然而，對於血液透析病人罹患心房顫動的關係仍有待進一步釐清。因此，本研究主要目的在探討血液透析病人與心房顫動的發生率及風險之相關性。方法：本研究係利用全民健康保險研究資料庫（2007年1月1日至2016年9月30日）選取15,622位長期接受血液透析的慢性腎臟病患者。另外，篩選出54,243位非慢性腎臟病者作為對照組個案。運用Cox比例風險模式估計血液透析病人罹患心房顫動的風險對比值及其百分之九十五信賴區間。結果：本研究發現在對照組及血液透析病人於追蹤期間分別有61,88及5,902位新發的心房顫動個案。相較於對照組個案，血液透析病人的心房顫動發生率比為2.29（95% CI=2.13-2.46）。調整相關危險因子後，血液透析病人罹患心房顫動的風險對比值為1.95（95% CI=1.76-2.17）。分層分析的研究結果顯示血液透析病人同時具有糖尿病、高血壓、高血脂及缺血性心臟病等共病時亦會有顯著較高罹患心房顫動的風險。結論：本研究結果發現年齡較大及同時具有其他共病的血液透析病人會有較高罹患心房顫動的風險。未來對於這些具有較高罹患心房顫動風險的血液透析病人的臨床照護需要更加注意，以期提高透析病人的生活品質。

並列關鍵字

心房顫動 ； 慢性腎臟病 ； 血液透析 ； 全民健康保險研究資料庫