Atrial fibrillation and risk of stroke in dialysis patients

Wetmore, James B.; Ellerbeck, Edward F.; Mahnken, Jonathan D.; Phadnis, Milind A.; Rigler, Sally K.; Mukhopadhyay, Purna; Spertus, John A.; Zhang, Xinhua; Hou, Qi; Shireman, Theresa I.

doi:10.1016/j.annepidem.2012.12.011

Cited by 58 publications

(52 citation statements)

References 25 publications

(58 reference statements)

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“…For example, in the Reasons for Geographic and Racial Differences in Stroke Study, the association of AF with myocardial infarction was significantly greater in blacks compared with in whites (5). Among prevalent patients with dialysis, chronic AF was significantly associated with higher risk of ischemic stroke, and this association was stronger in blacks compared with in whites (6). However, the differences in our findings from these other studies may be related to our focus on kidney-specific outcomes.…”

Section: Discussioncontrasting

confidence: 58%

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Atrial Fibrillation and Risk of ESRD in Adults with CKD

Bansal¹,

Xie²,

Tao³

et al. 2016

CJASN

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Background and objectives Atrial fibrillation frequently complicates CKD and is associated with adverse outcomes. Progression to ESRD is a major complication of CKD, but the link with atrial fibrillation has not been fully delineated. In this study, we examined the association of incident atrial fibrillation with the risk of ESRD in patients with CKD.Design, setting, participants, & measurements We studied participants in the prospective Chronic Renal Insufficiency Cohort Study without atrial fibrillation at entry. Incident atrial fibrillation was identified by study visit ECGs, self-report, and hospital discharge diagnostic codes, with confirmation by physician adjudication. ESRD through 2012 was ascertained by participant self-report, medical records, and linkage to the US Renal Data System. Data on potential confounders were obtained from self-report, study visits, and laboratory tests. Marginal structural models were used to study the potential association of incident atrial fibrillation with risk of ESRD after adjustment for time-dependent confounding.Results Among 3091 participants, 172 (5.6%) developed incident atrial fibrillation during follow-up. During mean follow-up of 5.9 years, 43 patients had ESRD that occurred after development of incident atrial fibrillation (11.8/ 100 person-years) compared with 581 patients without incident atrial fibrillation (3.4/100 person-years). In marginal structural models with inverse probability weighting, incident atrial fibrillation was associated with a substantially higher rate of ESRD (hazard ratio, 3.2; 95% confidence interval, 1.9 to 5.2). This association was consistent across important subgroups by age, sex, race, diabetes status, and baseline eGFR.Conclusions Incident atrial fibrillation was associated with higher risk of developing ESRD in CKD. Additional study is needed to identify potentially modifiable pathways through which atrial fibrillation was associated with a higher risk of progression to ESRD. More aggressive monitoring and treatment of patients with CKD and atrial fibrillation may improve outcomes in this high-risk population.

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Section: Discussioncontrasting

confidence: 58%

“…The incidence of AF is estimated to be two-to threefold higher (3) in patients with CKD compared with the general population. Moreover, AF is associated with poor outcomes, such as greater risks of ischemic stroke, myocardial infarction, and death (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation and Risk of ESRD in Adults with CKD

Bansal¹,

Xie²,

Tao³

et al. 2016

CJASN

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“…Associations with stroke are similar in the ESRD and general populations (44)(45)(46)55,56). In a recent study, for example, stroke incidence was 5.2/100 patient-years in patients with AF compared with 1.9/100 patient-years in dialysis patients without AF (46).…”

Section: Consequences Of Afmentioning

confidence: 93%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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“…A causal relationship between ischaemic stroke and atrial arrhythmias such as AF or atrial flutter remains undoubtable [2,3]. Numerous factors predisposing to peripheral embolism in patients with AF have been well defined, documented, and included in the CHA 2 DS 2 -VASc score [4].…”

Section: Introductionmentioning

confidence: 99%

AssesSment of the left atrial appendage morphoLogy in patients aAfter ischaeMic Stroke — the ASSAM study protocol

2017

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A b s t r a c tStroke remains the most dangerous and frightening complication of atrial fibrillation (AF). A causal relationship between ischaemic stroke and atrial arrhythmias such as AF or atrial flutter has been well established. Numerous factors predisposing to peripheral embolism in patients with AF have been well established and included in the CHA 2 DS 2 -VASc score. Although proper anticoagulation minimises the risk attributable to "known" risk factors, stroke may still occur. Thus, "unknown" risk factors may play an important role in stroke risk stratification in patients with AF. We assume that one of the important "unknown" risk factor is the left atrial appendage morphology. The ASSAM study is planned to include 100 patients after ischaemic stroke or transient ischaemic attack (TIA) and known status of anticoagulation at the time of stroke. The control group will consist of 100 patients scheduled for AF ablation without a history of stroke or TIA.

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Atrial fibrillation and risk of stroke in dialysis patients

Cited by 58 publications

References 25 publications

Atrial Fibrillation and Risk of ESRD in Adults with CKD

Atrial Fibrillation and Risk of ESRD in Adults with CKD

Arrhythmia and Sudden Death in Hemodialysis Patients

AssesSment of the left atrial appendage morphoLogy in patients aAfter ischaeMic Stroke — the ASSAM study protocol

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