Influence of atrial fibrillation on the morbido-mortality of patients on hemodialysis.
BACKGROUND
The consequences of atrial fibrillation (AF) on morbido-mortality of patients on hemodialysis have not been fully explored. The objective of this study was to determine the prevalence of AF in patients on hemodialysis and to evaluate its influence on the development of thromboembolic phenomena (TEP).


METHODS
The incidence of AF in 190 patients in our hemodialysis program was assessed, and the patients were followed up for 1 year. Pertinent demographic and biochemical parameters were entered into univariate and multivariate statistical analyses to evaluate associations with overall mortality and TEP such as cerebrovascular accident, transitory ischemic accident, or peripheral embolism.


RESULTS
In 13.6% of patients, AF was found; 9.4% of these were of the permanent type. In the multivariate analysis, only increased age was associated with a higher probability of having arrhythmia (odds ratio, 1.10; 95% confidence interval, 1.03-1.17; P =.003). During follow-up, 23% of the patients with AF died compared with 6% of those in sinus rhythm (P <.05), although AF did not appear to be an independent predictive factor for death. Thirty-five percent of the patients with AF and 4% with sinus rhythm had TEP (P <.01). In the multivariate analysis, AF was identified as the only independent predictor for TEP (odds ratio, 8; 95% CI, 2.3-27; P =.0008).


CONCLUSIONS
AF is a frequent arrhythmia in patients on hemodialysis, and approximately 1 in 3 hemodialysis patients with AF had thromboembolic complications within 1 year of follow-up. These findings suggest that the consensus contraindication of prophylactic anticoagulation therapy for this group of patients may need to be redefined.
Vázquez
E
E
Unidad de Cardiología and Servicio de Nefrología, Hospital General de Especialidades, Ciudad de Jaén, Spain. vazquez89@arrakis.es
Sánchez-Perales
C
C
Borrego
F
F
Garcia-Cortés
M J
MJ
Lozano
C
C
Guzmán
M
M
Gil
J M
JM
Borrego
M J
MJ
Pérez
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control
D000925:Anticoagulants