Dilemmas in the Management of Atrial Fibrillation in Chronic Kidney Disease
Dilemmas in the Management of Atrial Fibrillation in Chronic Kidney Disease
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DOI：
10.1681/asn.2007111207
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发表时间：
2009-04-01
影响因子：
13.6
通讯作者：
Breithardt, Guenter
中科院分区：
文献类型：
--
作者：
Reinecke, Holger;Brand, Eva;Breithardt, Guenter
慢性肾脏病（CKD）患者心血管疾病发病率和死亡率的风险增加。房颤问题很少受到关注，尽管这种心律失常在长期血液透析患者中很常见，患病率为 13% 至 27%。由于涉及大量病理生理机制，这些患者发生血栓栓塞事件和出血并发症的风险很高。中风是 CKD 的常见并发症：美国肾脏数据系统报告称，血液透析患者中风的发生率为 15.1%，而其他阶段 CKD 患者的发生率为 9.6%，无 CKD 的对照组为 2.6%。这些亚组中风后的 2 年死亡率分别为 74%、55% 和 28%。尽管口服香豆素是心房颤动的首选治疗方法，但仅在有限的研究中报道了其在 CKD 患者中的使用，且所有研究均在血液透析患者中进行，并且与非 CKD 患者相比，其出血率显着增加。针对脑卒中高风险和口服抗凝数据相互矛盾的问题，基于相关研究提出个体化分层算法。
Patients with chronic kidney disease (CKD) have an increased risk for cardiovascular morbidity and mortality. Little attention has been paid to the problem of atrial fibrillation, although this arrhythmia is very frequent with a prevalence of 13 to 27% in patients on long-term hemodialysis. Because of the large number of pathophysiologic mechanisms involved, these patients have a high risk for both thromboembolic events and hemorrhagic complications. Stroke is a frequent complication in CKD: The US Renal Data System reports an incidence of 15.1% in hemodialysis patients compared with 9.6% in patients with other stages of CKD and 2.6% in a control cohort without CKD. The 2-yr mortality rates after stroke in these subgroups were 74, 55, and 28%, respectively. Although oral coumadin is the treatment of choice for atrial fibrillation, its use in patients with CKD is reported only in limited studies, all in hemodialysis patients, and is associated with a markedly increased rate of bleeding compared with patients without CKD. With regard to the high risk for stroke and the conflicting data about oral anticoagulation, an individualized stratification algorithm is presented based on relevant studies.