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. 2025;56(6):713-723.
doi: 10.1159/000546266. Epub 2025 May 5.

Association between Parathyroid Hormone Concentration and Incident Atrial Fibrillation in Older Persons with Kidney Failure Initiating Dialysis

Pascale Khairallah  1 , Sai Liu  2 , Maria E Montez-Rath  2 , Kevin F Erickson  1 , Tara I Chang  2 , Wolfgang C Winkelmayer  3
Affiliations

Association between Parathyroid Hormone Concentration and Incident Atrial Fibrillation in Older Persons with Kidney Failure Initiating Dialysis

Pascale Khairallah et al. Am J Nephrol. 2025.

Abstract

Introduction: Atrial fibrillation (AF) is common in persons with kidney failure on hemodialysis. In the general population, higher intact parathyroid hormone (iPTH) levels were found to be associated with presence of AF. Whether iPTH associates with AF in patients on hemodialysis is unknown.

Methods: Using merged USRDS-DaVita data (2006-2011), we selected persons aged 67+ years who initiated hemodialysis and survived 120 days. Eligible persons had continuous Medicare A + B coverage from 2 years prior to kidney failure and no diagnosis of AF. Sociodemographic, comorbidity, and clinical information were abstracted from Medicare forms, billing claims, and electronic health records. iPTH was categorized consistent with previous work: <150; 150 to <300; 300 to <600; and ≥600 pg/mL. Patients were followed for incident (i.e., newly diagnosed) AF as reflected in inpatient and outpatient claims. Unadjusted and multivariable Cox regression were used to estimate the associations of time-updated iPTH category (referent: 150 to <300 pg/mL) with incident AF.

Results: Of 15,225 patients initiating hemodialysis, surviving 120 days, and without a prior diagnosis of AF, iPTH (in pg/mL) at baseline was <150 in 4,479, 150 to <300 in 5,964, 300 to <600 in 3,479, and ≥600 in 1,064 persons. During 21,845 patient-years, 2,857 patients had incident AF (rate, 13.1/100 person-years). After multivariable adjustment, patients with iPTH <150 pg/mL had 13% (95% confidence interval [CI]: 3-25%) higher relative AF incidence compared with the 150 to <300 pg/mL group, but no association was found for those with iPTH 300 to <600 (hazard ratio [HR]: 1.04; 95% CI: 0.95-1.14) or iPTH ≥600 pg/mL (HR: 0.90; 95% CI: 0.75-1.08).

Conclusion: Among persons with incident kidney failure on hemodialysis, compared with those whose iPTH was between 150 and <300 pg/mL, lower iPTH was independently associated with higher AF incidence; however, no association with AF was identified for higher iPTH levels.

Keywords: Arrhythmia; Cardiovascular; Dialysis; ESRD; Parathyroid hormone.

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Conflict of interest statement

Dr. Winkelmayer reports having served as a scientific advisor or consultant to Anthos, Akebia, AstraZeneca, Bayer, Boehringer Ingelheim, Cadrenal, GlaxoSmithKline, Idorsia, Merck, Natera, Novartis, and Vera, and on clinical trial committees for Akebia, Bayer, Merck, and NephroNET. He is a member of the Editorial Board of the American Journal of Nephrology. Dr. Erickson reports receiving personal fees from Acumen LLC and Dialysis Clinics Inc. and serving as a scientific advisor for Outset Medical, Fresenius Medical Care, and Boehringer Ingelheim. Tara I. Chang reports serving as a consultant for Bayer, Novo Nordisk, Prokidney, Alexion, Tricida, and the George Clinical Institute; and has received salary support from CSL Behring through funds paid directly to Stanford University. She has received research grant support from the American Heart Association and the National Institutes of Health. None of the remaining authors have any relationships with industry to disclose.

Figures

Fig. 1.
Fig. 1.
Study design. AF, atrial fibrillation; iPTH, intact parathyroid hormone. The baseline period extends up to 730 days prior to plus the first 120 days since dialysis initiation. The designated index date is day 121 after initiation of hemodialysis. Baseline covariates, iPTH concentration, and other dialysis parameters were assessed during the baseline period as depicted. The follow-up period begins at the index date and is divided into successive 30-day covariate assessment intervals, 30-day iPTH (exposure) intervals, and 30-day AF (outcome) intervals.
See this image and copyright information in PMC

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