Dilemmas in the Management of Atrial Fibrillation in Chronic Kidney Disease

Department of Cardiology and Angiology, Medizinische Klinik und Poliklinik C, University Hospital of Muenster, Muenster, Germany.
Journal of the American Society of Nephrology (Impact Factor: 9.47). 04/2009; 20(4):705-11. DOI: 10.1681/ASN.2007111207
Source: PubMed

ABSTRACT 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.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper deals with the calculation of the complete radiation pattern of a parabolic reflector antenna by using the induced currents method and the geometrical theory of diffraction in different regions, extended in particular to the case of a loaded rim. A package of computer programs is presented and a set of results, showing the possibility of improved radiation performances, is given.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the importance of cardiovascular disease in dialysis patients, the frequency of atrial fibrillation in incident dialysis patients has not been determined. We analyzed the prevalence of atrial fibrillation in patients starting dialysis over a 4-year period, its occurrence over the course of dialysis, and its influence on ischemic stroke and mortality. Factors predisposing to atrial fibrillation were noted, as was the influence of arrhythmia on mortality and presentation of ischemic stroke. Of the 256 patients studied, 31 had atrial fibrillation at the start of dialysis. Increased age, larger left atrium, and female gender were independently related to the presence of atrial fibrillation at dialysis inception. Of the 225 patients who were in sinus rhythm at the start of dialysis, 28 developed atrial fibrillation during a mean follow-up time of 2 years. The presence of valvular calcifications, bundle branch block, previous ischemic stroke, lower ejection fraction, higher pulse pressure, and lower hemoglobin concentration were predictors of the clinical evolution of atrial fibrillation. Overall, atrial fibrillation increased mortality risk 1.72-fold and ischemic stroke risk 9.8-fold. Therefore, it appears that atrial fibrillation is quite prevalent and its presence is associated with significant risk.
    Kidney International 07/2009; 76(3):324-30. DOI:10.1038/ki.2009.185 · 8.52 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: End-stage renal disease is associated with considerable cardiovascular morbidity and mortality. Atrial fibrillation (AF) is prevalent among dialysis patients and adversely affects the clinical outcome. Vazquez et al. report an increased prevalence and incidence of AF in patients who commence dialysis, and an independent association between arrhythmia and mortality risk. Moreover, they examined clinical and laboratory parameters associated with AF. This population study may fuel research aiming at the development of novel preventive and treatment strategies.
    Kidney International 08/2009; 76(3):247-9. DOI:10.1038/ki.2009.144 · 8.52 Impact Factor
Show more