Ischaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis.
OBJECTIVE
Little is known about the ischaemic stroke risk and benefit of warfarin therapy for stroke prevention in chronic kidney disease (CKD) patients on peritoneal dialysis (PD) with concomitant atrial fibrillation (AF). Our objective was to determine the risk of ischaemic stroke in a 'real-world' cohort of PD patients with AF, and clinical benefit or harm of aspirin and warfarin.


RESULTS
This is a single-centred observational study of Chinese patients with non-valvular AF. Hospitalizations with ischaemic stroke and intracranial haemorrhage (ICH) were recorded. Of 9810 patients from a hospital-based AF registry, 271 CKD patients on PD with AF (76.8 ± 12.5 years, CHA2DS2-VASc: 3.69 ± 1.83, and HAS-BLED: 2.07 ± 0.97) were identified. Amongst these PD patients, 24.7% received warfarin; 31.7% received aspirin; and 43.5% received no antithrombotic therapy. Amongst patients with no antithrombotic therapy, annual incidence of ischaemic stroke in PD patients was comparable with those non-CKD counterparts (9.32 vs. 9.30%/year). Similar to non-CKD patients, annual incidence of ischaemic stroke increased with increasing CHA2DS2-VASc score (CHA2DS2-VASc = 0-1: 5.76 vs. 5.70%/year, P = 1.00; and CHA2DS2-VASc ≥ 2: 10.80 vs. 9.94%/year, P = 0.78). Amongst PD patients, warfarin therapy was associated with lower risk of ischaemic stroke compared with aspirin [Hazard ratio (HR): 0.16, 95% confidence interval (CI): 0.04-0.66, P = 0.01] and no therapy (HR: 0.19, 95% CI: 0.06-0.65, P = 0.01), but not associated with a higher risk of ICH.


CONCLUSIONS
In CKD patients on PD with AF, who had similar ischaemic stroke risk as non-CKD counterparts, warfarin therapy is associated with reduction in risk of ischaemic stroke without a higher risk of ICH.
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Pak-Hei
PH
Chan
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Duo
D
Huang
Renal Division, Department of Medicine, Tung Wah Hospital, Hong Kong, China.
Pok-Siu
PS
Yip
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Jojo
J
Hai
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Hung-Fat
HF
Tse
Renal Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Tak-Mao
TM
Chan
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Gregory Y H
GY
Lip
Renal Division, Department of Medicine, Tung Wah Hospital, Hong Kong, China.
Wai-Kei
WK
Lo
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China cwdsiu@hku.hk.
Chung-Wah
CW
Siu
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006723:Hong Kong; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D016016:Proportional Hazards Models; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin
Atrial fibrillation; Chronic kidney disease; Ischaemic stroke; Peritoneal dialysis