Icodextrin is associated with a lower risk of atrial fibrillation in peritoneal dialysis patients

Aim: Dialysis patients with atrial fibrillation (AF) are at 1.72-fold increased mortality risk. This study investigated whether peritoneal dialysis (PD) patients using icodextrin were at a reduced risk of AF. Methods: From the Taiwan National Health Insurance database, we identified 4040 icodextrin users and 3517 non-users among 7557 patients newly diagnosed with end-stage renal disease undergoing PD from 2005 to 2011. The incidence of AF was compared between PD patients with and without icodextrin treatment by the end of 2011, with the hazard ratio (HR) of AF measured using Cox proportional hazards regression models. Results: The incidence of AF was 50% lower in icodextrin users than in non-users (2.14 vs 4.24 per 1000 person-years) with an adjusted HR of 0.49 (95% confidence interval (CI) = 0.28–0.85). The protective effect was greater for PD patients with diabetes (adjusted HR = 0.39, 95% CI = 0.17–0.86) than those without diabetes (adjusted HR = 0.57, 95% CI = 0.28–1.18). The beneficial effect of icodextrin treatment remained after controlling for the competing risk of deaths, with an adjusted sub-HR of 0.35 (95% CI = 0.16–0.75) for those with diabetes and 0.50 (95% CI = 0.26–0.99) for those without diabetes. Conclusion: The use of icodextrin solution is associated with a lower risk of new-onset AF in PD patients. The protective effectiveness was greater for those with diabetes.