Reinecke Holger, Brand Eva, Mesters Rolf, Schäbitz Wolf-Rüdiger, Fisher Marc, Pavenstädt Hermann, Breithardt Günter
Department of Cardiology and Angiology, Medizinische Klinik und Poliklinik C, University Hospital of Muenster, Muenster, Germany.
J Am Soc Nephrol. 2009 Apr;20(4):705-11. doi: 10.1681/ASN.2007111207. Epub 2008 Dec 17.
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.
慢性肾脏病（CKD）患者发生心血管疾病的发病率和死亡率风险增加。虽然心房颤动在长期血液透析患者中非常常见，患病率为13%至27%，但该问题很少受到关注。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都很高。中风是CKD的常见并发症：美国肾脏数据系统报告，血液透析患者中风发生率为15.1%，而处于CKD其他阶段的患者为9.6%，无CKD的对照队列中为2.6%。这些亚组中风后的2年死亡率分别为74%、55%和28%。虽然口服华法林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患者中的应用，所有研究对象均为血液透析患者，且与无CKD患者相比，出血率显著增加。鉴于中风的高风险以及口服抗凝治疗的数据相互矛盾，基于相关研究提出了一种个体化分层算法。
