Clinical characteristics of hemodialysis patients with atrial fibrillation: The RAKUEN (Registry of atrial fibrillation in chronic kidney disease under hemodialysis from Niigata) study
Clinical characteristics of hemodialysis patients with atrial fibrillation: The RAKUEN (Registry of atrial fibrillation in chronic kidney disease under hemodialysis from Niigata) study
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DOI：
10.1016/j.jjcc.2015.08.023
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发表时间：
2016-07-01
影响因子：
2.5
通讯作者：
Miyazaki, Shigeru
中科院分区：
文献类型：
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作者：
Mitsuma, Wataru;Matsubara, Taku;Miyazaki, Shigeru
背景：血液透析合并房颤 (AF) 患者的临床特征、治疗和结局仍不清楚。方法和结果：我们研究了 423 名接受维持性血液透析的日本患者（年龄 65.2 +/- 12.4 岁，男性 70%，平均血液透析持续时间 139 +/- 124 个月）。 19% (n = 82) 存在 AF，并且与年龄增加（比值比 1.070，95% 置信区间 1.043-1.098）、血液透析持续时间延长（比值比 1.006，95% 置信区间 1.004-1.008）和充血性心力衰竭（比值比 2.749，95% 置信区间）独立相关1.546-4.891）。在平均持续 36 个月的观察期间，AF 患者 (n = 82) 的全因死亡、心血管死亡和大出血（特别是胃肠道出血）的发生率显着高于非 AF 患者 (n = 341)（分别为 p < 0.001、p = 0.004、p = 0.002、p = 0.027），但缺血性卒中/全身性卒中的发生率 AF 和非 AF 患者的栓塞情况相似。 AF 与全因死亡（风险比 1.728，95% 置信区间 1.123-2.660）和大出血（风险比 1.984，95% 置信区间 1.010-3.896）独立相关。 33% 的 AF 患者服用了华法林，但在研究期间，华法林组 (n = 27) 和非华法林组 (n = 55) 的全因死亡、缺血性卒中和大出血发生率没有显着差异。结论：在我们的血液透析患者中，AF 是一种常见的合并症，与全因死亡和大出血独立相关，但与全因死亡和大出血风险增加无关。 缺血性中风。 (C) 2016 年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Clinical characteristics, management, and outcomes in hemodialysis patients with atrial fibrillation (AF) remain unclear.Methods and results: We studied 423 Japanese patients undergoing maintenance hemodialysis (age 65.2 +/- 12.4 years, male 70%, mean duration of hemodialysis 139 +/- 124 months). AF was present in 19% (n = 82) and was independently related to increased age (odds ratio 1.070, 95% confidence interval 1.043-1.098), longer hemodialysis duration (odds ratio 1.006, 95% confidence interval 1.004-1.008), and congestive heart failure (odds ratio 2.749, 95% confidence interval 1.546-4.891). During observations lasting a mean of 36 months, the incidences of all-cause death, cardiovascular death, and major bleeding, in particular gastrointestinal bleeding, were significantly higher in the AF (n = 82) than the non-AF (n = 341) patients (p < 0.001, p = 0.004, p = 0.002, p = 0.027, respectively), but the incidence of ischemic stroke/systemic embolism was similar in the AF and non-AF patients. AF was independently associated with all-cause death (hazard ratio 1.728, 95% confidence interval 1.123-2.660) and major bleeding (hazard ratio 1.984, 95% confidence interval 1.010-3.896). Warfarin was prescribed in 33% of the AF patients, but the rates of all-cause death, ischemic stroke, and major bleeding during the study period were not significantly different between warfarin (n = 27) and non-warfarin (n = 55) groups.Conclusions: In our hemodialysis patients, AF was a common comorbidity and was independently associated with all-cause death and major bleeding, but not with increased risk of ischemic stroke. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.