Death in dialysis patients results mainly from cardiovascular and cerebrovascular diseases. No prospective study has compared the rates of mortality or cardiovascular events between patients with and without atrial fibrillation at the time of dialysis initiation.
The study included 1,516 patients who were initiated into dialysis during 2011-2013 period. Rates of mortality and cardiovascular events were compared between patients with and without atrial fibrillation, and between atrial fibrillation patients with and without Warfarin ( Coumadin ) treatment.
The study comprised 1,025 men and 491 women with a mean age of 67.5 ± 13.1. Of these patients, 93 had atrial fibrillation, while 1,423 did not; 22.6% of the former group and 9.7% of the latter group died by March 2014 ( p less than 0.01 ).
Cardiovascular events occurred in 34.4% of patients with atrial fibrillation and 15.1% of patients without ( p less than 0.01 ).
Even after adjustments for various factors, atrial fibrillation remained an independent risk factor for mortality ( hazard ratio, HR=1.873, 95% CI 1.168-3.002, p less than 0.01 ).
It was also an independent risk factor for cardiovascular events ( HR=1.872, 95% CI 1.262-2.778, p less than 0.01 ).
No difference in any parameter was noted between the groups that did and did not receive treatment con Warfarin.
In conclusion, patients with atrial fibrillation at the time of dialysis initiation show a poor prognosis and are at high risk of cardiovascular events. Therefore, atrial fibrillation should be taken into consideration in dialysis patients. ( Xagena )
Tanaka A et al, Nephron 2016; Epub ahead of print