Vázquez E, Sánchez-Perales C, Borrego F, Garcia-Cortés M J, Lozano C, Guzmán M, Gil J M, Borrego M J, Pérez V
Unidad de Cardiología and Servicio de Nefrología, Hospital General de Especialidades, Ciudad de Jaén, Spain.
Am Heart J. 2000 Dec;140(6):886-90. doi: 10.1067/mhj.2000.111111.
The consequences of atrial fibrillation (AF) on morbido-mortality of patients on hemodialysis have not been fully explored. The objective of this study was to determine the prevalence of AF in patients on hemodialysis and to evaluate its influence on the development of thromboembolic phenomena (TEP).
The incidence of AF in 190 patients in our hemodialysis program was assessed, and the patients were followed up for 1 year. Pertinent demographic and biochemical parameters were entered into univariate and multivariate statistical analyses to evaluate associations with overall mortality and TEP such as cerebrovascular accident, transitory ischemic accident, or peripheral embolism.
In 13.6% of patients, AF was found; 9.4% of these were of the permanent type. In the multivariate analysis, only increased age was associated with a higher probability of having arrhythmia (odds ratio, 1.10; 95% confidence interval, 1.03-1.17; P =.003). During follow-up, 23% of the patients with AF died compared with 6% of those in sinus rhythm (P <.05), although AF did not appear to be an independent predictive factor for death. Thirty-five percent of the patients with AF and 4% with sinus rhythm had TEP (P <.01). In the multivariate analysis, AF was identified as the only independent predictor for TEP (odds ratio, 8; 95% CI, 2.3-27; P =.0008).
AF is a frequent arrhythmia in patients on hemodialysis, and approximately 1 in 3 hemodialysis patients with AF had thromboembolic complications within 1 year of follow-up. These findings suggest that the consensus contraindication of prophylactic anticoagulation therapy for this group of patients may need to be redefined.
心房颤动（AF）对血液透析患者的发病和死亡影响尚未得到充分研究。本研究的目的是确定血液透析患者中AF的患病率，并评估其对血栓栓塞现象（TEP）发生的影响。
评估了我们血液透析项目中190例患者的AF发生率，并对患者进行了1年的随访。将相关的人口统计学和生化参数纳入单变量和多变量统计分析，以评估与全因死亡率和TEP（如脑血管意外、短暂性脑缺血发作或外周栓塞）的相关性。
在13.6%的患者中发现了AF；其中9.4%为永久性AF。在多变量分析中，只有年龄增加与心律失常的发生概率较高相关（比值比，1.10；95%置信区间，1.03 - 1.17；P = 0.003）。随访期间，AF患者中有23%死亡，而窦性心律患者中这一比例为6%（P < 0.05），尽管AF似乎不是死亡的独立预测因素。AF患者中有35%发生TEP，窦性心律患者中这一比例为4%（P < 0.01）。在多变量分析中，AF被确定为TEP的唯一独立预测因素（比值比，8；95%CI，2.3 - 27；P = 0.0008）。
AF是血液透析患者中常见的心律失常，在随访1年内，约三分之一的AF血液透析患者发生了血栓栓塞并发症。这些发现表明，对于这组患者预防性抗凝治疗的共识性禁忌可能需要重新定义。
