Mitsuma Wataru, Matsubara Taku, Hatada Katsuharu, Imai Shunsuke, Saito Noriko, Shimada Hisaki, Miyazaki Shigeru
Division of Cardiology, Shinrakuen Hospital, Niigata, Japan.
Division of Cardiology, Shinrakuen Hospital, Niigata, Japan.
J Cardiol. 2016 Aug;68(2):148-55. doi: 10.1016/j.jjcc.2015.08.023. Epub 2015 Oct 31.
Clinical characteristics, management, and outcomes in hemodialysis patients with atrial fibrillation (AF) remain unclear.
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.
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.
心房颤动（AF）的血液透析患者的临床特征、治疗及预后仍不明确。
我们研究了423例接受维持性血液透析的日本患者（年龄65.2±12.4岁，男性占70%，平均血液透析时间139±124个月）。AF患者占19%（n = 82），且与年龄增长（比值比1.070，95%置信区间1.043 - 1.098）、更长的血液透析时间（比值比1.006，95%置信区间1.004 - 1.008）以及充血性心力衰竭（比值比2.749，95%置信区间1.546 - 4.891）独立相关。在平均为期36个月的观察期内，AF患者（n = 82）的全因死亡、心血管死亡及大出血（尤其是胃肠道出血）发生率显著高于非AF患者（n = 341）（p < 0.001、p = 0.004、p = 0.002、p = 0.027），但AF患者与非AF患者的缺血性卒中/全身性栓塞发生率相似。AF与全因死亡（风险比1.728，95%置信区间1.123 - 2.660）及大出血（风险比1.984，95%置信区间1.010 - 3.896）独立相关。33%的AF患者使用了华法林，但在研究期间，华法林组（n = 27）与非华法林组（n = 55）的全因死亡、缺血性卒中和大出血发生率无显著差异。
在我们的血液透析患者中，AF是一种常见的合并症，且与全因死亡和大出血独立相关，但与缺血性卒中风险增加无关。
