title: Clinical characteristics of hemodialysis patients with atrial fibrillation: The RAKUEN (Registry of atrial fibrillation in chronic kidney disease under hemodialysis from Niigata) study.
abstract: Clinical characteristics, management, and outcomes in hemodialysis patients with atrial fibrillation (AF) remain unclear.
  
  
  
  We studied 423 Japanese patients undergoing maintenance hemodialysis (age 65.2±12.4 years, male 70%, mean duration of hemodialysis 139±124 months). AF was present in 19% (n=82) and was independently related to increased age (odds ratio 1.070, 95% confidence interval 1.043-1.098), longer hemodialysis duration (odds ratio 1.006, 95% confidence interval 1.004-1.008), and congestive heart failure (odds ratio 2.749, 95% confidence interval 1.546-4.891). During observations lasting a mean of 36 months, the incidences of all-cause death, cardiovascular death, and major bleeding, in particular gastrointestinal bleeding, were significantly higher in the AF (n=82) than the non-AF (n=341) patients (p<0.001, p=0.004, p=0.002, p=0.027, respectively), but the incidence of ischemic stroke/systemic embolism was similar in the AF and non-AF patients. AF was independently associated with all-cause death (hazard ratio 1.728, 95% confidence interval 1.123-2.660) and major bleeding (hazard ratio 1.984, 95% confidence interval 1.010-3.896). Warfarin was prescribed in 33% of the AF patients, but the rates of all-cause death, ischemic stroke, and major bleeding during the study period were not significantly different between warfarin (n=27) and non-warfarin (n=55) groups.
  
  
  
  In our hemodialysis patients, AF was a common comorbidity and was independently associated with all-cause death and major bleeding, but not with increased risk of ischemic stroke.
authors.affiliation: Division of Cardiology, Shinrakuen Hospital, Niigata, Japan. Electronic address: mwataru@hotmail.com.
authors.forename: Wataru
authors.initials: W
authors.lastname: Mitsuma
authors.affiliation: Division of Cardiology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Division of Cardiology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Katsuharu
authors.initials: K
authors.lastname: Hatada
authors.affiliation: Division of Cardiology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Imai
authors.affiliation: Division of Nephrology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Saito
authors.affiliation: Division of Nephrology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Hisaki
authors.initials: H
authors.lastname: Shimada
authors.affiliation: Division of Nephrology, Shinrakuen Hospital, Niigata, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D004617:Embolism / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; Bleeding; Hemodialysis; Stroke; Warfarin