Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis

Abuhasira, Ran; Mizrakli, Yuval; Shimony, Avi; Novack, Victor; Shnaider, Alla; Haviv, Yosef S.

doi:10.1038/s41598-018-21229-9

Cited by 13 publications

(19 citation statements)

References 23 publications

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“…Another Taiwanese retrospective cohort study of 15,947 patients in 2016 showed that the incidence of AF was higher among hemodialysis patients [24]. In another study of 1,130 ESRD patients conducted in 2017, 26.9% of the cohort were noted to have AF during the study period [25]. In the present cohort, 14.5% of the incident ESRD patients had AF at the initiation of hemodialysis, confirming the high prevalence and incidence of AF in dialysis population.…”

Section: Discussionsupporting

confidence: 72%

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

et al. 2020

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BackgroundAtrial fibrillation (AF) is highly prevalent, occurring in 1%-2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, suggesting that AF is a possible risk factor for mortality of ESRD patients. However, whether the existence of AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients remains to be defined.Methods . The end points were mortality of patients or the end of the study. Incident ESRD patients who were on maintenance hemodialysis for more than 3 months were eligible for inclusion. Cox proportional regression and Kaplan-Meier survival curves were used to determine the association between predictors and mortality. The association between AF and echocardiographic parameters, causes of death were also investigated. ResultsOf the 393 incident ESRD patients at initiation of hemodialysis, 57 (14.5%) had AF and the median age was 71 years. Patients with AF were significantly older; showed significantly higher C-reactive protein levels, more heart failure, chronic obstructive pulmonary disease and mortality. Multivariate Cox regression showed that AF had a hazard ratio of 4.1 (95% confidence interval: 2.4-7.0) for mortality. Age-specific analysis showed that AF was significantly associated with mortality in all age groups. Echocardiography measurements including ejection fraction and left ventricular hypertrophy (LVH) were similar in AF and non-AF patients. Cause-specific analysis showed that AF significantly associated with overall cardiovascular death and death due to acute myocardial infarction/coronary artery disease and sepsis. ConclusionsAF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients regardless of age. The systolic function and degree of LVH were similar in AF and non-AF patients. The association between AF and sepsis-related death suggested the role of systemic inflammation on the pathogenesis of AF.

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Section: Discussionsupporting

confidence: 72%

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

et al. 2020

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“…In fact, hemodialysis procedure itself has been identi ed as a trigger for AF (17). Studies comparing the incidence rate of AF in non-dialysis and dialysis patients with CKD do not exist, but AF incidence has been numerically higher in CKD patients undergoing dialysis (5,9,(11)(12)(13). One previous trial reported a higher incidence rate of AF in dialysis patients compared to healthy controls (13).…”

Section: Discussionmentioning

confidence: 99%

Elevated Troponin T and enlarged left atrium predict the incidence of atrial fibrillation in patients with chronic kidney disease stage 4-5

Hakamäki¹,

Hellman²,

Lankinen³

et al. 2020

Preprint

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Background Atrial fibrillation (AF) and chronic kidney disease (CKD) are commonly co-existing conditions. However, data on epidemiology of AF in patients with CKD stage 4–5 is scarce. Methods We prospectively enrolled 210 consecutive non-dialysis patients with CKD stage 4–5 between 2013 and 2017. Follow-up data on AF incidence along with medical history, laboratory tests and echocardiography at baseline were gathered. Results At baseline, mean age was 62 years, estimated glomerular filtration rate 12.8 ml/min and 73/210 (34.8%) of the participants were female. Altogether 41/210 (19.5%) patients had a previous diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF occurred in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age > 60 years (HR 4.27, CI95% 1.57–11.64, p < 0.01), elevated troponin T (TnT) > 50 ng/l (HR 3.61, CI95% 1.55–8.37, p < 0.01) and left atrial volume index (LAVI) > 30 ml/m2 (HR 4.82, CI95% 1.11-21.00, p = 0.04) independently predicted the incidence of new-onset AF. Conclusions The prevalence and incidence of AF was markedly high in this prospective study on patients with CKD stage 4–5. Elevated TnT and increased LAVI were identified as independent predictors for new-onset AF in patients with severe CKD.

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“…17 Incident AF in prevalent ESRD patients was also noted to be associated with increased mortality risk. 4 Therefore, AF in the presence of kidney disease deserves special attention and management.…”

Section: Epidemiology Of Af and Cva In Esrdmentioning

confidence: 99%

“…3 Larger left atrium, higher systolic blood pressure, and increased age were additional risk factors for AF. 3,4 In addition to AF, risk of stroke (event rate of 5.61 per 100 person years) in ESRD patients is greatly increased as compared to those without renal impairment (event rate of 3.61 per 100 person years), 5 which is very concerning due to the already increased CV mortality among ESRD patients.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

Goel¹,

Jain²,

Haddad³

et al. 2020

J Stroke

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End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA<sub>2</sub>DS<sub>2</sub>-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

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Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis

Cited by 13 publications

References 23 publications

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

Elevated Troponin T and enlarged left atrium predict the incidence of atrial fibrillation in patients with chronic kidney disease stage 4-5

Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

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