title: The high incidence of left atrial appendage thrombosis in patients on maintenance haemodialysis.
abstract: BACKGROUND
  The incidence of intracardiac thrombosis in haemodialysis patients has not been studied. Here we determined the incidence in end-stage renal disease patients on maintenance haemodialysis.
  
  
  METHODS
  Transoesophageal echocardiography was performed in 215 patients (125 males, 90 females; mean age 60 +/- 9 years). Any potential candidate with current or past chronic or intermittent atrial fibrillation or with cardiovascular diseases was excluded from the study.
  
  
  RESULTS
  Thrombi were found in the left atrial appendages in 71 out of 215 subjects (33%). Based on multiple logistic regression analyses, the probability of finding a thrombus was found to be increased in patients on chronic antiplatelet therapy (odds ratio 4.268) and in those with diabetes mellitus and a low haematocrit (</=0.3; odds ratio 7.173). Other clinical parameters, including gender, age, duration of haemodialysis, blood pressure, left ventricular dimension, smoking habit or type of anticoagulation during dialysis, were not associated with the incidence of left atrial appendage thrombosis.
  
  
  CONCLUSIONS
  Maintenance haemodialysis patients have a high incidence of left atrial appendage thrombosis. Either chronic use of antiplatelet drugs or the background conditions requiring antiplatelet therapy, and the concomitant presence of diabetes mellitus and a low haematocrit may be involved in left atrial appendage thrombosis.
authors.affiliation: Cardiovascular Division, Toujinkai Hospital, Momoyama-cho, Kyoto, Japan. tojinkai.hosp@dream.com
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Toyofumi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Koji
authors.initials: K
authors.lastname: Okino
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Nakamura
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ono
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology