Mitsuma Wataru, Matsubara Taku, Hatada Katsuharu, Imai Shunsuke, Tamura Makoto, Tsubata Yutaka, Ikarashi Kozo, Morioka Tetsuo, Saito Noriko, Shimada Hisaki, Miyazaki Shigeru
Divisions of Cardiology, Shinrakuen Hospital, Japan.
Divisions of Nephrology, Shinrakuen Hospital, Japan.
Intern Med. 2018 Aug 15;57(16):2295-2300. doi: 10.2169/internalmedicine.0021-17. Epub 2018 Mar 30.
Objective The progress of non-anticoagulated patients with atrial fibrillation (AF) undergoing hemodialysis has not been determined. Using data from the RAKUEN (Registry of Atrial fibrillation in chronic Kidney disease Under hEmodialysis from Niigata) study, we examined the clinical characteristics and outcomes among hemodialysis patients with AF who were not receiving a vitamin K antagonist (VKA). Methods and Results Forty-three of 423 patients undergoing hemodialysis (-10%) were prescribed a VKA. The remaining 380 patients (age 64.8±12.8 years, male 70%) were enrolled in the present study. During a mean observation period of 36 months, AF (n=55) was independently associated with all-cause death (hazard ratio, 1.82; 95% confidence interval, 1.12-2.94; p=0.014), but was not associated with ischemic stroke (hazard ratio, 1.91; 95% confidence interval, 0.74-4.92; p=0.177) and major bleeding (hazard ratio, 1.80; 95% confidence interval, 0.80-4.08; p=0.150). The crude incidence rates of all-cause death and ischemic stroke in the AF patients were 15.75 (2.5-fold higher compared to the non-AF patients) and 3.63 (1.7-fold higher compared to the non-AF patients) per 100 person-years, respectively. Conclusion A great impact on death, but not ischemic stroke, was observed in non-anticoagulated hemodialysis patients with AF in comparison to those without AF from the analysis of the RAKUEN study.
目的 尚未明确未接受抗凝治疗的心房颤动（AF）患者进行血液透析后的病情进展情况。利用来自RAKUEN（新潟慢性肾脏病血液透析患者心房颤动登记研究）的数据，我们研究了未接受维生素K拮抗剂（VKA）治疗的血液透析AF患者的临床特征及预后。方法与结果 423例接受血液透析的患者中有43例（-10%）使用了VKA。其余380例患者（年龄64.8±12.8岁，男性占70%）纳入本研究。在平均36个月的观察期内，AF（n = 55）与全因死亡独立相关（风险比，1.82；95%置信区间，1.12 - 2.94；p = 0.014），但与缺血性卒中无关（风险比，1.91；95%置信区间，0.74 - 4.92；p = 0.177），也与大出血无关（风险比，1.80；95%置信区间，0.80 - 4.08；p = 0.150）。AF患者的全因死亡和缺血性卒中的粗发病率分别为每100人年15.75例（比非AF患者高2.5倍）和3.63例（比非AF患者高1.7倍）。结论 根据RAKUEN研究分析，与无AF的血液透析患者相比，未接受抗凝治疗的AF血液透析患者对死亡有很大影响，但对缺血性卒中无影响。
