Primary prevention of atrial fibrillation with beta-blockers in patients with end-stage renal disease undergoing dialysis

Lin, Ting Tse; Chiang, Jiun Yang; Liao, Min‐Tsun; Tsai, Chia Ti; Hwang, Juey‐Jen; Chiang, Fu Tien; Lin, Jiunn Lee; Lin, Lian Yu

doi:10.1038/srep17731

Cited by 10 publications

(14 citation statements)

References 71 publications

(55 reference statements)

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“…A caliper width of 0.15 standard deviations was used for matching as in our previous study. 17 Laboratory data, echocardiographic and CMRI parameters were compared within propensity score matched group. The Pearson correlation analysis was used to investigate the correlation between intramyocardial fat content, epicardial fat, and several diastolic parameters among the three groups.…”

Section: Discussionmentioning

confidence: 99%

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Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Lee

Hsu

et al. 2019

European J of Heart Fail

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Aims It has been proposed that an increase of myocardial adiposity is related to left ventricular (LV) diastolic dysfunction. The specific roles of myocardial steatosis including epicardial fat and intramyocardial fat for diastolic function are unknown in those patients suffering heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF). This study aims to determine the complex relationship between myocardial adiposity in patients with HFrEF or HFpEF. Methods and results Using cardiac magnetic resonance imaging (CMRI), myocardial steatosis was measured in 305 subjects (34 patients with HFrEF, 163 with HFpEF, and 108 non‐HF controls). We also evaluated cardiac structure and diastolic and systolic function by echocardiography and CMRI. Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non‐HF controls [intramyocardial fat content (%), 1.56 (1.26, 1.89) vs. 0.75 (0.50, 0.87) and 1.0 (0.79, 1.15), P < 0.05]. Intramyocardial fat amount (%) was higher in HFpEF women than in men [1.91% (1.17%, 2.32%) vs. 1.22 (0.87%, 2.02%), P = 0.01]. When estimated by CMRI (left ventricular peak filling rate), echocardiographic E/e′ level, or left atrial volume index, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients, and this was independent of age, co‐morbidities, body mass index, gender, and myocardial fibrosis (standardized coefficient: β = −0.34, P = 0.03; β = 0.29, P = 0.025; and β = 0.25, P = 0.02, respectively). Conclusions Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non‐HF controls. Independent of risk factors or gender, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients.

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Section: Discussionmentioning

confidence: 99%

“…According to the propensity score, patients were selected by 1:1 matching without replacement using the nearest neighbour method. A caliper width of 0.15 standard deviations was used for matching as in our previous study . Laboratory data, echocardiographic and CMRI parameters were compared within propensity score matched group.…”

Section: Methodsmentioning

confidence: 99%

Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Lee

Hsu

et al. 2019

European J of Heart Fail

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“…We identified 4,284 references in total, of which 4,236 were excluded based on screening of titles and abstracts, and 48 were evaluated further by full text, including 3 RCTs [9,[25][26][27][28] and 9 observational studies finally deemed eligible for inclusion [19,20,[29][30][31][32][33][34][35].…”

Section: Resultsmentioning

confidence: 99%

“…The reason may be that evidence on the benefits of β-blockers in patients receiving dialysis is insufficient currently. Most randomized controlled trials (RCTs) on β-blockers have excluded patients with advanced chronic kidney disease due to the risk of side effects, such as fluid overload, intradialytic muscle cramping, hypotension, and hyperkalemia [15][16][17][18], whereas some observational studies have demonstrated better survival and cardiovascular outcomes in dialysis patients treated with β-blockers [19,20].…”

Section: Doi: 101159/000496083mentioning

confidence: 99%

Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

Jin

Guo

2019

Blood Purif

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Background: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, β-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of β-blockers therapy in adult patients treated with dialysis. Methods: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of β-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. Results: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between β-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54–0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29–0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31–0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48–0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80–0.92) between β-blockers and no β-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57–1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50–1.26). Conclusions: β-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/496083?sponsor=52

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“…Primary prevention of AF with β-blockers in patients with ESRD may be a better answer. 83 As all of the NOACs are, at least in part, eliminated by the kidneys, the assessment of kidney function before considering this type of therapy is a prerequisite. The most common methods used to estimate the GFR are the measurement of creatinine clearance, and the estimation formulas based on serum creatinine levels include the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and the Chronic Kidney Disease Epidemiology Collaboration formulas.…”

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confidence: 99%

Management of patients with atrial fibrillation and chronic kidney disease in light of the latest guidelines

Młodawska¹,

Tomaszuk‐Kazberuk²,

Łopatowska³

et al. 2016

Polish Archives of Internal Medicine

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REVIEW ARTICLE Management of patients with AF and CKD 353link with AF because it leads not only to anatomic and metabolic changes in the cardiovascular system but also to alterations in the endocrine and nervous systems, hematopoiesis, and inflammatory response, which increases the risk of AF.2 The overload of the extracellular fluid might lead to left ventricular hypertrophy and ventricular diastolic dysfunction, which causes atrial remodeling, a well-known pathogenesis of AF. 6AF frequently occurs in renal failure population and ranges from 19% to 24%, rising to 27% in patients with end-stage renal disease (ESRD). 5,7In the Framingham Heart Study, 8 the prevalence of AF in patients with CKD was 15-fold higher than that in the general population, while in the Chronic Renal Insufficiency Cohort study, 9 AF was Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1% to 2% of the general population. 1,2 The percentage of patients with AF increases with age from 0.14% in those younger than 50 years old, 4% in those between 60 and 70 years old, to 14% in those over 80 years old. 3 AF is a well-known risk factor for cardiovascular morbidity, especially thromboembolic complications (including ischemic stroke), and mortality that resulted in 112 000 deaths in 2013, compared with 29 000 deaths in 1990. 1,2,4During the past 10 years, chronic kidney disease (CKD) has been also identified as a major risk factor for cardiovascular morbidity and mortality, with rapidly increasing prevalence.5 Impairment of kidney function has a well-established ABSTRACTAtrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD), and the rate reaches even 30% in patients with end-stage renal disease (ESRD). Patients with AF and CKD have a significantly higher risk of thrombotic complications, particularly ischemic stroke, and at the same time, a higher bleeding risk (proportionally to the grade of renal failure). In addition, AF and CKD share a number of comorbidities and risk factors, which results in increased mortality rates. Moreover, disturbances in hemostasis are common complications of kidney disease. Their occurrence and severity correlate with worsening renal function, including ESRD. At present, the incidence of bleeding is declining, while thrombotic complications have become the predominant cause of mortality. Prophylactic antithrombotic treatment reduces the rate of stroke and other thrombotic complications. Vitamin K antagonists (VKAs) have long been used in anticoagulant therapy, and more recently, non-vitamin K oral anticoagulants (NOACs) have been introduced, which are direct thrombin inhibitors. NOACs are a valuable anticoagulant option in this group of patients as long as a summary of product characteristics is followed. They are at least as effective as warfarin, while being safer, especially when it comes to intracranial hemorrhage. Renal function should be evaluated before initiation of NOACs and reevaluated when clinically indicated. Importantly, disturb...

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Primary prevention of atrial fibrillation with beta-blockers in patients with end-stage renal disease undergoing dialysis

Cited by 10 publications

References 71 publications

Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

Management of patients with atrial fibrillation and chronic kidney disease in light of the latest guidelines

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