scholarly journals Increased risk of atrial fibrillation in end-stage renal disease patients on dialysis

Medicine ◽  
2016 ◽  
Vol 95 (25) ◽  
pp. e3933 ◽  
Author(s):  
Cheng-Huang Shen ◽  
Cai-Mei Zheng ◽  
Kee-Thai Kiu ◽  
Hsin-An Chen ◽  
Chia-Chang Wu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

2020 ◽  
Vol 22 (3) ◽  
pp. 306-316
Author(s):  
Narender Goel ◽  
Deepika Jain ◽  
Danny B. Haddad ◽  
Divya Shanbhogue
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Decision Making ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA2DS2-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

Abstract 17741: Atrial Fibrillation and Incident End-Stage Renal Disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Wesley T O’Neal ◽  
Rikki Tanner ◽  
Jimmy T Efird ◽  
Usman Baber ◽  
Alvaro Alonso ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Renal Disease ◽  
Racial Differences ◽  
End Stage Renal Disease ◽  
Increased Risk ◽  
Regards Study ◽  
Stage Renal Disease ◽  
End Stage ◽  
Study Participants

Background: Recently, it has been shown that atrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD). However, the association between AF and incident ESRD has not been examined in the general population. Methods: A total of 25,315 study participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified in study participants at baseline (2003- 2007) by the study electrocardiogram and self-reported history of a physician diagnosis. Incident cases of ESRD were identified through linkage of REGARDS participants with the United States Renal Data System. Cox proportional-hazards regression was used to generate hazard ratios (HR) and 95% confidence intervals (95%CI) for the association between ESRD and AF. Results: A total of 2,190 (8.7%) participants had AF at baseline. Over a median follow-up of 7.7 years, 295 (1.2%) participants developed ESRD. In multivariable adjusted models, AF was associated with an increased risk of incident ESRD (Table 1). However, the association between AF and ESRD became non-significant after adjustment for baseline markers of CKD. Similar results were obtained when albumin-to-creatinine ratio was included in the model as a continuous variable (log-transformed). An interaction between AF and CKD was not detected. Conclusion: AF is associated with an increased risk of ESRD in the general population. However, this association potentially is explained by underlying CKD.

Oral Anticoagulants in Patients With Atrial Fibrillation and End-Stage Renal Disease

2019 ◽  
Vol 24 (6) ◽  
pp. 499-508
Author(s):  
Junaid A. B. Zaman ◽  
Anil K. Bhandari
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Additional Risk ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

The role of oral anticoagulants (OAC) in atrial fibrillation (AF) is well established. However, none of the randomized controlled trials included patients with end-stage renal disease (ESRD) leaving a lack of evidence in this large, challenging and unique patient group. Patients on hemodialysis (HD) with AF have additional risk factors for stroke due to vascular comorbidities, HD treatment, age, and diabetes. Conversely, they are also at increased risk of major bleeding due to uremic platelet impairment. Anticoagulants increase bleeding risk in patients with ESRD and HD up to 10-fold compared with non chronic kidney disease (CKD) patients on warfarin. There are conflicting data and recommendations regarding use of OACs in ESRD which will be reviewed in this article. We conclude by proposing a modified strategy for OAC use in ESRD based on the latest evidence.

Could Antioxidant Supplementation Delay Progression of Cardiovascular Disease in End-Stage Renal Disease Patients?

2020 ◽  
Vol 19 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Stefanos Roumeliotis ◽  
Athanasios Roumeliotis ◽  
Xenia Gorny ◽  
Peter R. Mertens
Keyword(s):  
Oxidative Stress ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Close Association ◽  
Omega 3 ◽  
Endstage Renal Disease ◽  
Increased Risk ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage

In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV) origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating antioxidant defence systems. During the last decade, a close association of oxidative stress with accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.

scholarly journals Increased Risk of End-Stage Renal Disease in Familial IgA Nephropathy

2002 ◽  
Vol 13 (2) ◽  
pp. 453-460
Author(s):  
Francesco Paolo Schena ◽  
Giuseppina Cerullo ◽  
Michele Rossini ◽  
Salvatore Giovanni Lanzilotta ◽  
Christian D’Altri ◽  
...  
Keyword(s):  
Renal Disease ◽  
Iga Nephropathy ◽  
End Stage Renal Disease ◽  
Upper Respiratory Tract ◽  
Renal Survival ◽  
First Degree Relatives ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
Tract Infections ◽  
End Stage

ABSTRACT. Primary IgA nephropathy (IgAN) is characterized by recurrent episodes of macroscopic hematuria accompanied by upper respiratory tract infections or persistent asymptomatic microscopic hematuria with or without proteinuria. IgAN may involve one or more members of a family. Three generations of a cohort of 110 patients with biopsy-proven IgAN, living in Southern Italy, were checked for urinalysis, and the relative risk (RR) of developing the disease was evaluated. A total of 19 unrelated familial, 37 suspected, and 54 sporadic cases of IgAN were identified. Renal survival was estimated by the Kaplan-Meier method for censored data and compared by use of the log-rank test. More than 50% of the patients with IgAN clustered in kindred with more than two probably affected relatives. In 19 unrelated IgAN families, 8 had single-generation (SG) and 11 multigenerational (MG) involvement showing a prevalent vertical transmission of the trait. The RR was 16 times higher in first-degree relatives (odds ratio [OR], 16.4; 95% confidence interval [CI], 5.7 to 47.8; P < 0.0001) and >2 times higher, even if NS, in second-degree relatives (OR, 2.4; 95 % CI, 0.7 to 7.9; P = 0.145). The clinical and histologic picture of familial and sporadic IgAN appeared to be similar. The 20-yr renal survival rate from the apparent onset of the disease was significantly poorer in patients with familial (41%) than in patients with sporadic (94%) IgAN (P = 0.003). Furthermore, 15-yr renal survival from the time of renal biopsy was significantly worse in familial IgAN (P = 0.02); end-stage renal disease was present in 64% of familial and only in 8% of patients with sporadic IgAN. Finally, renal survival was significantly worse in patients belonging to families with SG rather than with MG involvement (P = 0.03). These data show, for the first time, that familial IgAN may be considered a nonbenign disease that occurs frequently in first-degree relatives. Familial IgAN has a poorer outcome than sporadic IgAN. Therefore, an accurate family history and urinalysis in all family members is urgently recommended in clinical practice. This procedure might avoid late referral of subjects with persistent and underestimated urinary abnormalities and late diagnosis of the disease.

scholarly journals Treatment of atrial fibrillation with warfarin among older adults with end stage renal disease

2017 ◽  
Vol 30 (6) ◽  
pp. 831-839 ◽  
Author(s):  
Jingwen Tan ◽  
Sunjae Bae ◽  
Jodi B. Segal ◽  
Junya Zhu ◽  
Dorry L. Segev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage
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