Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan.
Department of Nephrology, Teine Keijinkai Hospital, Sapporo, Japan.
Clin Exp Nephrol. 2021 Mar;25(3):297-304. doi: 10.1007/s10157-020-01991-9. Epub 2020 Nov 18.
Atrial fibrillation (AF) is an established risk factor for ischemic stroke in a general population. However, its impact in patients on hemodialysis (HD), a group with a high risk for stroke, is still controversial. Here we examined this issue in a Japanese cohort.
This study was designed as a multicenter cohort study. HD patients (n = 1,067) were enrolled from 22 institutes in January 2009 and followed up for 3 years. Patients with missing data (n = 196) or kidney transplantation (n = 4) were excluded, and 867 patients contributed to the analysis of the risk of new-onset of ischemic stroke.
At baseline, AF was observed in 123 patients (14.2%, AF group) and not in the others (n = 744: 85.8%, non-AF group). During a follow-up period of 31.3 months, the cumulative incidence rate for ischemic stroke was significantly higher in the AF group than in the non-AF group (6.5% vs. 2.9%, p < 0.05). In Cox regression analysis, AF was a significant independent risk factor for new-onset of ischemic stroke after adjustment for age, sex, prior history of ischemic stroke, use of warfarin, dialysis vintage, comorbidity of diabetic nephropathy, and interdialytic weight gain (hazard ratio 2.17-2.68).
Present analyses using comprehensive adjustment for multiple confounders, including prior history of ischemic stroke, indicated that AF independently increases the risk of new-onset of ischemic stroke by more than twofold in Japanese HD patients.
心房颤动（AF）是普通人群发生缺血性卒中的既定危险因素。然而，在透析患者（HD）中，这一人群卒中风险较高，其影响仍存在争议。本研究在日本队列中对此问题进行了研究。
本研究设计为多中心队列研究。2009 年 1 月从 22 家机构招募 HD 患者（n=1067），并随访 3 年。排除数据缺失（n=196）或肾移植（n=4）的患者，867 例患者参与分析缺血性卒中的新发病例风险。
基线时，123 例患者（14.2%，AF 组）存在 AF，而其他 744 例患者（85.8%，非 AF 组）未发现 AF。在 31.3 个月的随访期间，AF 组的缺血性卒中累积发生率明显高于非 AF 组（6.5% vs. 2.9%，p<0.05）。Cox 回归分析表明，在校正年龄、性别、既往缺血性卒中史、华法林使用、透析年限、糖尿病肾病合并症和透析间体重增加等多个混杂因素后，AF 是缺血性卒中新发病例的独立危险因素（风险比 2.17-2.68）。
本研究使用综合调整多种混杂因素，包括既往缺血性卒中史的分析表明，AF 可使日本 HD 患者新发缺血性卒中的风险增加两倍以上。
