I-Kuan Wang1,2,3, Kuo-Hung Lin4, Shih-Yi Lin1,2,3, Cheng-Li Lin5,6, Chiz-Tzung Chang3, Tzung-Hai Yen7,8, Fung-Chang Sung1,5,9. 1. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. 2. Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan. 3. Division of Nephrology, China Medical University Hospital, Taichung, Taiwan. 4. Division of Cardiology, China Medical University Hospital, Taichung, Taiwan. 5. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. 6. College of Medicine, China Medical University, Taichung, Taiwan. 7. Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan. 8. Chang Gung University College of Medicine, Taoyuan, Taiwan. 9. Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND: Studies investigating the risk of cardiac dysrhythmia warranting permanent pacemaker therapy for end-stage renal disease (ESRD) patients are limited. This study investigated the incidence rate of permanent cardiac pacing in dialysis patients. METHODS: Using the Taiwan National Health Insurance Database, we identified 28 471 newly diagnosed ESRD patients in 2000-2010 [9700 on peritoneal dialysis (PD) and 18 771 on hemodialysis (HD)] and 113 769 randomly selected controls without kidney disease, frequency-matched by sex, age and diagnosis date. We also established propensity score-matched HD and PD cohorts with 9700 patients each. Incidence rates and hazard ratios (HRs) of implantation were evaluated by the end of 2011. Complications were also evaluated among patients with implantation. RESULTS: The incidence rates of permanent pacemaker implantation were 5.93- and 3.50-fold greater in HD and PD patients than in controls (1.44 and 0.85 versus 0.24 per 1000 person-years, respectively). The adjusted HRs (aHRs) of implantation were 3.26 [95% confidence interval (CI) = 2.41-4.42] and 2.36 (95% CI = 1.56-3.58) for HD and PD patients, respectively, compared with controls. The pacemaker implantation rate was 0.33 per 1000 person-years greater in the propensity score-matched HD cohort than in the PD cohort, with an aHR of 1.30 (95% CI = 0.82-2.05) for the HD cohort compared with the PD cohort. CONCLUSIONS: Dialysis patients are at an increased risk of dysrhythmia requiring pacemaker implantation compared with the general population. The risks are not significantly different between HD and PD patients.
BACKGROUND: Studies investigating the risk of cardiac dysrhythmia warranting permanent pacemaker therapy for end-stage renal disease (ESRD) patients are limited. This study investigated the incidence rate of permanent cardiac pacing in dialysis patients. METHODS: Using the Taiwan National Health Insurance Database, we identified 28 471 newly diagnosed ESRDpatients in 2000-2010 [9700 on peritoneal dialysis (PD) and 18 771 on hemodialysis (HD)] and 113 769 randomly selected controls without kidney disease, frequency-matched by sex, age and diagnosis date. We also established propensity score-matched HD and PD cohorts with 9700 patients each. Incidence rates and hazard ratios (HRs) of implantation were evaluated by the end of 2011. Complications were also evaluated among patients with implantation. RESULTS: The incidence rates of permanent pacemaker implantation were 5.93- and 3.50-fold greater in HD and PDpatients than in controls (1.44 and 0.85 versus 0.24 per 1000 person-years, respectively). The adjusted HRs (aHRs) of implantation were 3.26 [95% confidence interval (CI) = 2.41-4.42] and 2.36 (95% CI = 1.56-3.58) for HD and PDpatients, respectively, compared with controls. The pacemaker implantation rate was 0.33 per 1000 person-years greater in the propensity score-matched HD cohort than in the PD cohort, with an aHR of 1.30 (95% CI = 0.82-2.05) for the HD cohort compared with the PD cohort. CONCLUSIONS: Dialysis patients are at an increased risk of dysrhythmia requiring pacemaker implantation compared with the general population. The risks are not significantly different between HD and PDpatients.