Atrial Fibrillation in Chronic Hemodialysis Patients: Prevalence, Types, Predictors, and Treatment Practices in Greece

Abstract

Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, is associated with increased mortality and cardiovascular morbidity both in nonuremic and (recently) in dialysis patients. The aims of this study are: (i) to assess the prevalence of AF, the risk factors, and predictors of its presence in a cohort of incident hemodialysis (HD) patients in Greece and (ii) to report on current practices in the management of these patients. This is a prospective, cross-sectional, multicenter study of 574 patients on a regular HD program for >6 months. Demographic characteristics, cause of renal disease, cardiovascular risk factors, medication use, dialysis data (Kt/V, dialysis method, type of dialysate), 12-lead electrocardiogram (ECG) (interdialytic day), and cardiac echo data were collected. Pertinent demographic, ECG, and echocardiographic data were entered into univariate and multivariate analyses to evaluate associations with AF. The CHADS2 score (congestive heart failure [HF], hypertension, age ≥ 75, diabetes, previous stroke/transient ischemic attack [TIA]) was estimated and clinical practices in high-risk (CHADS2 score ≥ 2) patients were evaluated. The cohort included 368 men (64.1%) and 206 (35.8%) women (mean age 65.1 ± 14.4 years) with a mean duration on dialysis of 72.1 ± 60.4 months. Hypertension (75.6%) and coronary artery disease (47.2%) were the commonest cardiovascular risk factors for AF. The prevalence of AF was 23.2% and showed an age-dependent increase; in patients <50 years, AF was present in 9.3%, while in patients ≥ 80 years, its prevalence increased to 36.4%. Furthermore, 8.3% of patients had permanent, 1.8% persistent, 12.7% paroxysmal AF, while the prevalence of paroxysmal atrial flutter and sick sinus syndrome were 1.2 and 2%, respectively. Logistic regression analysis showed that age, smoking, left atrial and aortic root diameter, β-blocker and α-calcidol use, HF, and the presence of valvular calcifications (VC) on cardiac echo were independently associated to the presence of AF. VC on cardiac echo had an almost sevenfold increased association with AF (odds ratio 6.72, 95% confidence interval 3.23-13.98, P < 0.0001). Only 25.5% of high-risk (CHADS2 score ≥ 2) patients were receiving anticoagulants. AF is a frequent arrhythmia in HD patients. Apart from well-known risk factors, VC merits special attention in this patient population. Less than one-third of high-risk AF patients receive anticoagulants, possibly reflecting the absence of definite guidelines for the management of AF in HD patients.

Effect of Frequent or Extended Hemodialysis on Cardiovascular Parameters: A Meta-analysis

“…This is noteworthy, in light of the increasing prevalence of atrial fibrillation in the HD population 64,77,78 . Atrial fibrillation is the most common cardiac arrhythmia in patients receiving HD and is associated with increased mortality 77,78 . The identification of potentially modifiable risk factors of this arrhythmia is imperative.…”

“…An LAEDD of greater than 40 mm has been shown to predict the development of atrial fibrillation in patients treated with conventional HD, and is an important predictor of lack of response to medical therapy 76,77 . This is noteworthy, in light of the increasing prevalence of atrial fibrillation in the HD population 64,77,78 . Atrial fibrillation is the most common cardiac arrhythmia in patients receiving HD and is associated with increased mortality 77,78 .…”

Predicting in a predicament: Stroke and hemorrhage risk prediction in dialysis patients with atrial fibrillation

“…Atrial fibrillation is the most common cardiac arrhythmia worldwide with an exceedingly high incidence and prevalence in the dialysis population. The prevalence ranges from 3.8% to 26.5% across countries, with a much higher prevalence in older patients . In hemo‐ and peritoneal dialysis patients, there are 1.5‐fold and 1.3‐fold reported increases in the adjusted risk relative to the general population .…”

Chronic Kidney Disease and Cardiovascular Diseases: Focus on Atrial Fibrillation

“…Распростра-ненность ФП увеличивается с 0,7% в общей популяции в возрасте до 60 лет до 27% среди пациентов с ТПН, и оказывает отрицательное влияние на долгосрочный прогноз пациентов с различными стадиями ХБП, а так-же обусловливает заметное увеличение частоты и про-должительности их госпитализаций [13][14][15].Так, из-вестное исследование Atherosclerosis Risk in Community (ARIC) показало, что у пациентов со СКФ в различ-ных интервалах: 60-89, 30-59, и 15-29 мл/мин/ 1,73 м 2 , соотношение риска развития ФП (в пределах 10-летнего периода наблюдения) составляет, соот-ветственно: 1,3, 1,6 и 3,2 по сравнению с лицами с нор-мальной СКФ [16]. Крупное проспективное исследо-вание, проведенное в японской популяции (n=235 518), продемонстрировало, что, с одной стороны, наличие у больного признаков ХБП сопряжено с увеличением риска возникновения ФП, а с другой -наличие ФП значимо предрасполагает к развитию и прогрессиро-ванию ХБП вплоть до ТПН [13].…”