Kaartinen Kati, Rautavaara Joonas, Aitkoski Atte, Anttonen Olli, Ahvonen Jani, Vilpakka Mari, Koistinen Juhani, Vääräniemi Kati, Miettinen Marja, Ylitalo Antti, Laine Kaisa, Ojanen Seppo, Kerola Tuomas, Nieminen Tuomo
Clin Nephrol. 2020 Sep;94(3):127-134. doi: 10.5414/CN109997.
Fluid overload and atrial fibrillation (AF) are frequently encountered in patients with end-stage renal disease (ESRD). We used subcutaneously insertable cardiac monitors (ICM) to detect AF and associated it with the hydration status, determined with a body composition monitor (BCM) in dialysis patients.
69 patients were recruited. Fluid overload was defined based on BCM measurements as a ratio of overhydration (OH) and extracellular water (OH/ECW) of > 15% at baseline. AF episodes lasting ≥ 2 minutes were collected.
45 in-center hemodialysis patients, 11 on peritoneal dialysis, 12 on home hemodialysis, and 1 predialysis-stage patient were followed up for a median of 2.9 years (25 - 75 percentile 1.9 - 3.1). 29% were overhydrated at baseline, and the percentage remained similar throughout the study. Overhydrated patients had a lower body mass index, a higher prevalence of type 1 diabetes mellitus (DM) and diabetic nephropathy, higher systolic blood pressure, greater ultrafiltration (UF) during dialysis, and a smaller lean tissue index than normohydrated patients. Chronic or paroxysmal AF was known to occur in 20.3% at entry, and a further 33.3% developed AF during the study, with an overall prevalence 53.6%. In univariable logistic regression, OH/ECW > 15% was strongly associated with AF prevalence (OR 6.8, 95% CI 1.7 - 26.5, p = 0.006), as were UF, age, coronary heart disease (CHD), DM, and the echocardiogram-derived ejection fraction and left atrial diameter. In multivariable analyses, OH/ECW > 15% remained an independent predictor of AF alongside age and CHD.
The occurrence of AF is independently associated with BCM-measured fluid overload, which is common among ESRD patients.
液体超负荷和心房颤动（AF）在终末期肾病（ESRD）患者中经常出现。我们使用皮下植入式心脏监测器（ICM）来检测AF，并将其与通过身体成分监测器（BCM）测定的透析患者的水合状态相关联。
招募了69名患者。根据BCM测量结果，将液体超负荷定义为基线时过度水合（OH）与细胞外液（OH/ECW）的比率>15%。收集持续≥2分钟的AF发作情况。
45名中心血液透析患者、11名腹膜透析患者、12名家用血液透析患者和1名透析前阶段患者接受了中位时间为2.9年的随访（第25至75百分位数为1.9至3.1）。29%的患者在基线时存在过度水合，且在整个研究过程中该百分比保持相似。与水合正常的患者相比，过度水合的患者体重指数较低，1型糖尿病（DM）和糖尿病肾病的患病率较高，收缩压较高，透析期间超滤量（UF）较大，瘦组织指数较小。已知20.3%的患者在入组时发生慢性或阵发性AF，在研究期间另有33.3%的患者发生AF，总体患病率为53.6%。在单变量逻辑回归中，OH/ECW>15%与AF患病率密切相关（比值比6.8，95%置信区间1.7 - 26.5，p = 0.006），UF、年龄、冠心病（CHD）、DM以及超声心动图得出的射血分数和左心房直径也是如此。在多变量分析中，OH/ECW>15%与年龄和CHD一样，仍然是AF的独立预测因素。
AF的发生与BCM测量的液体超负荷独立相关，液体超负荷在ESRD患者中很常见。
