title: Atrial fibrillation in haemodialysis patients: do the guidelines for anticoagulation apply?
abstract: OBJECTIVE
  Atrial fibrillation (AF) is common in haemodialysis patients, but the risks and benefits of anticoagulation in this group are not well characterized. We investigated the prevalence of AF, its associated risk factors, and the incidence of stroke and haemorrhage in a cohort of haemodialysis patients.
  
  
  METHODS
  We retrospectively reviewed 155 patients undergoing maintenance haemodialysis on 1 April 2003 (age 56.9 +/- 13.5 years; men 62.6%; mean duration of haemodialysis 39.3 +/- 37.5 months). Patients with paroxysmal or permanent AF were identified, and baseline clinical and echocardiographic data were obtained. The incidence of cerebrovascular accidents, major haemorrhage and all-cause mortality was assessed during the 26 month average follow-up period.
  
  
  RESULTS
  AF was present in 25.8% of patients, paroxysmal in 18.1%, and permanent in 7.7%. Patients with AF were more likely to be older (64.2 +/- 9.4 vs 54.4 +/- 13.8 years; P < 0.005), have underlying ischaemic heart disease or congestive heart failure, and have a lower serum albumin (P < 0.05 for all). Only 12.5% of AF patients were anticoagulated, although 47.5% had contraindications to warfarin. Cerebrovascular events occurred in 5.2% of all patients (30.4 episodes/1000 patient-years), and major haemorrhage in 20.0% (106.4 episodes/1000 patient-years). All-cause mortality was 29.7%. The endpoints for the AF group did not significantly differ from the non-AF group.
  
  
  CONCLUSIONS
  AF is common in haemodialysis patients. The incidence of major haemorrhage was over three times that of cerebrovascular accidents. Guideline recommendations for anticoagulation in AF in the general population may not be appropriate for the haemodialysis population.
authors.affiliation: Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand. andrewcyto@gmail.com
authors.forename: Andrew Cy
authors.initials: AC
authors.lastname: To
authors.forename: Maha
authors.initials: M
authors.lastname: Yehia
authors.forename: John F
authors.initials: JF
authors.lastname: Collins
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D017410:Practice Guidelines as Topic; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D020521:Stroke / Q000453:epidemiology / Q000209:etiology