Hemodialysis vs peritoneal dialysis immediately prior to a first kidney transplantation is associated with a higher risk for newly-diagnosed atrial fibrillation, investigators reported at the 2023 American Transplant Congress in San Diego, California.

Using data from the US Renal Data System, United Network for Organ Sharing, and Medicare parts A and B, Leonardo Pozo Garcia, MD, of Baylor College of Medicine in Houston, Texas, and colleagues studied 43,621 adult patients receiving their first kidney transplant who did not have previously diagnosed atrial fibrillation. Prior to transplantation, 37,034 patients used hemodialysis and 6587 used peritoneal dialysis. Patients had a mean age of 51 years.

Patients previously on hemodialysis had a significant 18% increased risk for atrial fibrillation compared with those previously on peritoneal dialysis, after adjusting for multiple variables, Dr Pozo Garcia reported. Graft failure was significantly associated with a 2.8-fold increased risk for atrial fibrillation.

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In addition, longer dialysis vintage was significantly associated with a 5% increased risk per year for atrial fibrillation.

Transplant factors also affected atrial fibrillation risk. Receiving a kidney from a female vs male donor was significantly associated with a 1.1-fold increased risk for atrial fibrillation, respectively, whereas receiving a kidney from a living donor was significantly associated with a 25% decreased risk.

“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 who were on peritoneal dialysis,” Dr Pozo Garcia told Renal & Urology News. He noted that factors associated with hemodialysis such as higher rates of heart failure, left atrium enlargement, impaired left ventricle contractility and ejection fraction, and hemodynamic changes related to dialysis access might contribute to the discrepancy between dialysis modalities.

“Both classic atrial fibrillation and transplant-related risk factors play a role in the development of post-transplant atrial fibrillation. As our understanding of transplant-specific risk factors for atrial fibrillation increases, we may be able to better risk-stratify the kidney transplant population and develop monitoring and management strategies that can improve outcomes.”


Pozo Garcia L, Liu S, Lenihan C, et al. Association of pre-transplant dialysis modality with incident atrial fibrillation following kidney transplantation. Presented at: ATC 2023, San Diego, California, June 3-7. Abstract C191.