Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital of Muenster, Muenster, Germany.
Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
Kidney Int. 2015 Jan;87(1):200-9. doi: 10.1038/ki.2014.195. Epub 2014 Jun 4.
Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality but there are few studies available about atrial fibrillation, the most frequent arrhythmia in CKD, and the applied treatment. Based on the prospective German Competence NETwork on Atrial Fibrillation, data of 3138 patients with atrial fibrillation were analyzed and categorized by their estimated glomerular filtration rate (stages 1-3 and 4 plus 5). With advanced CKD, significantly more patients suffered from a more severe form of atrial fibrillation. Despite significantly higher CHADS2 scores in advanced CKD, oral anticoagulation was not prescribed more frequently while antiarrhythmic drugs and catheter ablations were used significantly less often, in contrast to more pacemaker implantations. However, in multivariate hierarchical logistic regression analyses of in-hospital treatments and complications, only hemorrhages and pacemaker implantations turned out to be independently and significantly associated with higher CKD stages. This nationwide study shows that patients with CKD and atrial fibrillation suffer from a markedly higher comorbidity. Thus, while CKD patients have received cardioversions, ablations, antiarrhythmic, or anticoagulation drugs significantly less often in their history, current treatments were not different if adjusted for multiple comorbidities. This might indicate an improvement in the often reported therapeutic nihilism in CKD.
慢性肾脏病（CKD）与心血管发病率和死亡率增加有关，但关于心房颤动（CKD 中最常见的心律失常）及其应用治疗的研究很少。基于前瞻性德国心房颤动网络，对 3138 例心房颤动患者的数据进行了分析，并根据其估计肾小球滤过率（1-3 期和 4 期加 5 期）进行了分类。随着 CKD 的进展，患有更严重形式的心房颤动的患者明显增多。尽管 CKD 患者的 CHADS2 评分显著升高，但抗凝治疗的处方频率并没有增加，而抗心律失常药物和导管消融的使用频率明显降低，与之相反，起搏器植入的频率却增加了。然而，在住院治疗和并发症的多变量层次逻辑回归分析中，只有出血和起搏器植入与更高的 CKD 分期呈独立且显著相关。这项全国性研究表明，CKD 合并心房颤动的患者合并症明显更高。因此，尽管 CKD 患者在过去的治疗中接受过电复律、消融术、抗心律失常药物或抗凝药物治疗的频率明显较低，但如果考虑到多种合并症，目前的治疗方法并无差异。这可能表明，在 CKD 中经常报道的治疗上的消极态度有所改善。
