scholarly journals Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tapio Hellman ◽  
Markus Hakamäki ◽  
Roosa Lankinen ◽  
Niina Koivuviita ◽  
Jussi Pärkkä ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
P Wave ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

scholarly journals Elevated Troponin T and enlarged left atrium predict the incidence of atrial fibrillation in patients with chronic kidney disease stage 4-5

2020 ◽  
Author(s):  
Markus Hakamäki ◽  
Tapio Hellman ◽  
Roosa Lankinen ◽  
Niina Koivuviita ◽  
Jussi Pärkkä ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Troponin T ◽  
Volume Index ◽  
Elevated Troponin ◽  
Stage 4 ◽  
Ckd Stage ◽  
New Onset

Abstract Background Atrial fibrillation (AF) and chronic kidney disease (CKD) are commonly co-existing conditions. However, data on epidemiology of AF in patients with CKD stage 4–5 is scarce. Methods We prospectively enrolled 210 consecutive non-dialysis patients with CKD stage 4–5 between 2013 and 2017. Follow-up data on AF incidence along with medical history, laboratory tests and echocardiography at baseline were gathered. Results At baseline, mean age was 62 years, estimated glomerular filtration rate 12.8 ml/min and 73/210 (34.8%) of the participants were female. Altogether 41/210 (19.5%) patients had a previous diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF occurred in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age > 60 years (HR 4.27, CI95% 1.57–11.64, p < 0.01), elevated troponin T (TnT) > 50 ng/l (HR 3.61, CI95% 1.55–8.37, p < 0.01) and left atrial volume index (LAVI) > 30 ml/m2 (HR 4.82, CI95% 1.11-21.00, p = 0.04) independently predicted the incidence of new-onset AF. Conclusions The prevalence and incidence of AF was markedly high in this prospective study on patients with CKD stage 4–5. Elevated TnT and increased LAVI were identified as independent predictors for new-onset AF in patients with severe CKD.

scholarly journals The low-protein diet for chronic kidney disease: 8 years of clinical experience in a nephrology ward

2019 ◽  
Vol 13 (2) ◽  
pp. 253-260 ◽  
Author(s):  
Ivano Baragetti ◽  
Ilaria De Simone ◽  
Cecilia Biazzi ◽  
Laura Buzzi ◽  
Francesca Ferrario ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease

Abstract Background Guidelines indicate that a low-protein diet (LPD) delays dialysis in severe chronic kidney disease (CKD). We assessed the value of these guidelines by performing a retrospective analysis in our renal clinical practice. Methods The analysis was performed from 1 January 2010 to 31 March 2018 in 299 CKD Stage 4 patients followed for 70 months in collaboration with a skilled nutritionist. The patients included 43 patients on a controlled protein diet (CPD) of 0.8 g/kg/day [estimated glomerular filtration rate (eGFR) 20–30 mL/min/1.73 m2 body surface (b.s.)], 171 patients on an LPD of 0.6 g/kg/day and 85 patients on an unrestricted protein diet (UPD) who were not followed by our nutritionist (LPD and UPD, eGFR &lt;20 mL/min/1.73 m2 b.s.). Results eGFR was higher in CPD patients than in UPD and LPD patients (21.9 ± 7.4 mL/min/1.73 m2 versus 17.6 ± 8.00 mL/min/1.73 m2 and 17.1 ± 7.5 mL/min/1.73 m2; P = 0.008). The real daily protein intake was higher in UPD patients than in LPD and CDP patients (0.80 ± 0.1 g/kg/day versus 0.6 ± 0.2 and 0.63 ± 0.2 g/kg/day; P = 0.01). Body mass index (BMI) was stable in the LPD and CPD groups but decreased from 28.5 ± 4.52 to 25.4 ± 3.94 kg/m2 in the UPD group (P &lt; 0.001). The renal survival of UPD, LPD and CPD patients was 47.1, 84.3 and 90.7%, respectively, at 30 months (P &lt; 0.001), 42.4, 72.0 and 79.1%, respectively, at 50 months (P &lt; 0.001) and 42.4, 64.1 and 74.4%, respectively, at 70 months (P &lt; 0.001). The LPD patients started dialysis nearly 24 months later than the UPD patients. Diet was an independent predictor of dialysis [−67% of RR reduction (hazard ratio = 0.33; confidence interval 0.22–0.48)] together with a reduction in BMI. Conclusions An LPD recommended by nephrologists in conjunction with skilled dietitians delays dialysis and preserves nutritional status in severe CKD.

scholarly journals Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4–5 patients transitioning to dialysis and transplantation–A prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0258055
Author(s):  
Mikko J. Järvisalo ◽  
Viljami Jokihaka ◽  
Markus Hakamäki ◽  
Roosa Lankinen ◽  
Heidi Helin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Oral Health ◽  
Kidney Disease ◽  
Dental Health ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Stage 4 ◽  
Ckd Stage ◽  
Maintenance Dialysis

Background and aims Oral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline. Methods Altogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly. Results PTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, p<0.0001) mortality, as well as, incident MACEs (HR 1.071 95% CI 1.031–1.113, p = 0.0004) in the multivariable Cox models adjusted for age and kidney transplantation or CKD treatment modality during follow-up. Conclusions Radiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.

Preexisting Chronic Kidney Disease and Dyslipidemia are Strong Predictors for Early Acute Cerebrovascular Event After Isolated Coronary Artery Bypass Grafting: A Single Cardiac Center Experience

2020 ◽  
Vol 29 (1) ◽  
pp. 8-13
Author(s):  
Leonardo Paskah Suciadi ◽  
Andreas Hartanto Santoso ◽  
Irvan Cahyadi ◽  
Hoo Felicia Davina Hadi Gunawan ◽  
Joshua Henrina Sudjaja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Kidney Disease ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Onset Atrial Fibrillation ◽  
New Onset

The outcomes of coronary artery bypass grafting (CABG) surgery are determined by numerous factors. This study aimed to analyze the factors contributing to short-term outcomes of patients undergoing isolated CABG. This retrospective analysis enrolled all adult patients undergoing isolated CABG at our center between January 2013 and December 2016. Clinical characteristics and postoperative events were recorded and analyzed. Overall, 242 patients (mean age, 59.7 ± 9.5 years) were included. The majority of the patients (88.4%) were men. The median left ventricular ejection fraction (LVEF) was 50% ± 15%, with 38% patients having an LVEF lower than 40% and 9.1% having an LVEF lower than 25%. The mean preoperative creatinine level was 1.25 ± 0.73, and the estimated glomerular filtration rate was 68.55 ± 23 ml/min/1.73 m2. The intensive cardiac care unit stay and total in-hospital stay were 70 ± 59 h and 8 ± 4 days, respectively. The in-hospital mortality rate was 2.1%. The most common major adverse events were new-onset atrial fibrillation (31.8%) and significant worsening of renal function (21.5%). Stroke occurred in 3.7% patients, for which preexisting chronic kidney disease (CKD) and dyslipidemia were strong predictors (P < 0.05; area under the curve [AUC], 87.7%). Advanced age and hypertension were considered significant risk factors for developing new-onset atrial fibrillation (P < 0.05; AUC 65%). Worsening renal function and new-onset atrial fibrillation were the most frequent complications that occurred during hospitalization following CABG. Preexisting CKD and dyslipidemia were the major risk factors for developing acute stroke post surgery. KEYWORDS Acute cerebrovascular events, Chronic kidney disease, Coronary artery bypass grafting, Dyslipidemia.

scholarly journals Stroke and Major Bleeding when Switching from Warfarin to Apixaban in Patients with Advanced Chronic Kidney Disease and Prevalent Atrial Fibrillation

2021 ◽  
Author(s):  
Katherine Garlo ◽  
Thomas Mavrakanas ◽  
Wei Wang ◽  
Elisabeth Burdick ◽  
David Charytan
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Major Bleeding ◽  
The United States ◽  
Bleeding Events ◽  
Part D ◽  
Stage 4 ◽  
Ischemic Attack

Abstract Background Apixaban is the most widely used direct oral anticoagulant in patients with chronic kidney disease (CKD). Data on the incidence of stroke and major bleeding after switching from warfarin to apixaban in patients with prevalent atrial fibrillation (AF) and CKD are limited.Methods Warfarin users with stage 4-5 CKD not on dialysis and non-valvular AF prior to Jan 1,2012 were identified from the United States Data Renal System CKD dataset and individuals switching to apixaban from Jan 1,2012 -Dec 31, 2015 were identified. The incidence of stroke (ischemic or hemorrhagic), transient ischemic attack, or systemic thromboembolism and major bleeding events were estimated. Outcomes were compared between individuals switching to apixaban and those continuing warfarin using survival analyses with inverse probability treatment weighting. Individuals were censored at the time of anticoagulation discontinuation, loss of Medicare part D coverage, dialysis, kidney transplant, a 2nd switch in anticoagulant class, or death. Results 1762 individuals with advanced CKD and AF were initially on warfarin; 71 (4.0%) switched to apixaban (57.8% male, mean age 78.2 years (SD ±6.6), 78.9% white, mean CHA2DS2-VASc 5.0 (SD ±1.5), mean HAS-BLED 2.2 (SD ±0.5) and 1691 (96.0%) continued warfarin (47.6% male, mean age 80.1 years (SD ±8.7), 87.9% white, mean CHA2DS2-VASc 5.5 (SD ±1.6), mean HAS-BLED 2.5 (SD ±0.8). The incidence of stroke in the apixaban switch and warfarin continuation groups were 0.02/patient-year (95%CI 0.002-0.12) and 0.06/patient-year (95%CI 0.05-0.07) (p=0.21). Incidence of major bleeding were 0.02/patient-year (95% CI 0.002-0.13) and 0.06 (95% CI 0.03-0.04) (p =0.44) in the switch and warfarin groups, respectively. In adjusted models, the risk of stroke (HR 0.27 (95% CI 0.04-1.99)) and major bleeding (HR 0.41 (95% CI 0.06-3.02)) trended lower in the apixaban switch compared to the warfarin continuation group.Conclusions The incidence and risk of stroke and major bleeding trended lower in individuals with stage 4-5 CKD and prevalent AF who switched from warfarin to apixaban than individuals continuing warfarin. Our findings support a strategy of switching prevalent AF patients with late stage CKD from warfarin to apixaban. Additional studies including a larger number of events with a longer-duration of follow-up are needed to refine effect estimates.

Elevated Troponin T and Enlarged Left Atrium Are Associated with the Incidence of Atrial Fibrillation in Patients with CKD Stage 4–5

Nephron ◽  
2020 ◽  
Vol 145 (1) ◽  
pp. 71-77
Author(s):  
Markus Hakamäki ◽  
Tapio Hellman ◽  
Roosa Lankinen ◽  
Niina Koivuviita ◽  
Jussi Pärkkä ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Troponin T ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Elevated Troponin ◽  
Left Atrial Volume Index ◽  
Stage 4 ◽  
Ckd Stage ◽  
New Onset

<b><i>Introduction:</i></b> Atrial fibrillation (AF) and CKD are commonly coexisting conditions. However, data on epidemiology of AF in patients with CKD stage 4–5 is scarce. <b><i>Methods:</i></b> We prospectively enrolled 210 consecutive non-dialysis patients with CKD stage 4–5 between 2013 and 2017. Follow-up data on AF incidence along with medical history, laboratory tests, and echocardiography at baseline were gathered. <b><i>Results:</i></b> At baseline, mean age was 62 years, estimated glomerular filtration rate 12.8 mL/min, and 73/210 (34.8%) participants were female. Altogether, 41/210 (19.5%) patients had a previous diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF occurred in 33/169 (19.5%) patients (69.9 events/1,000 person-years). In the Cox proportional hazard model, age &#x3e;60 years (HR 4.27, CI 95% 1.57–11.64, <i>p</i> &#x3c; 0.01), elevated troponin T (TnT) &#x3e;50 ng/L (HR 3.61, CI 95% 1.55–8.37, <i>p</i> &#x3c; 0.01), and left atrial volume index (LAVI) &#x3e;30 mL/m<sup>2</sup> (HR 4.82, CI 95% 1.11–21.00, <i>p</i> = 0.04) were independently associated with the incidence of new-onset AF. <b><i>Conclusion:</i></b> The prevalence and incidence of AF was markedly high in this prospective study on patients with CKD stage 4–5. Elevated TnT and increased LAVI were independently associated with the occurrence of new-onset AF in patients with severe CKD.

Abstract 2451: Chronic Kidney Disease as an Independent Risk Factor for New-Onset Atrial Fibrillation in Patients with Essential Hypertension

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Takeshi Horio ◽  
Yoshio Iwashima ◽  
Kei Kamide ◽  
Takeshi Tokudome ◽  
Hiroto Nakata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rank Test ◽  
Hypertensive Patients ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Lv Mass ◽  
New Onset

Atrial fibrillation (AF) is frequently observed in hypertensive heart disease. Older age, increased left ventricular (LV) mass, and left atrial (LA) dilatation are known to be risk factors for the occurrence of AF in hypertensive patients. Chronic kidney disease (CKD) has recently been recognized to be a powerful risk for cardiovascular events. However, no study has revealed the association between CKD and the onset of AF. Thus, the present study assessed the hypothesis that CKD may influence the onset of AF in hypertensives. A total of 1,118 essential hypertensive patients (mean age, 63 years) without previous paroxysmal AF, heart failure, myocardial infarction, valvular disease, or LV asynergy were enrolled. In echocardiographic examinations, LA dimension and LV mass index (LVMI) were determined. Estimated glomerular filtration rate (eGFR) was calculated by the modified MDRD formula. During follow-up periods (mean, 4.7 years), fifty-seven cases of new onset AF (including paroxysmal AF) were found (1.1% /year). Cumulative event-free rates by the Kaplan-Meier method were decreased according to the decrease in basal eGFR (≥60, 30 – 60, 15–30, and <15 mL/min) and the increase in proteinuria (−/±, 1+/2+, and ≥3+) (log-rank test P<0.001, respectively). When CKD was defined as decreased eGFR (<60 mL/min) and/or the presence of proteinuria, the prevalence of new-onset AF was significantly higher in subjects with CKD (n=420) than without CKD (n=698) (7.9% vs 3.4%, P=0.001). Kaplan-Meier curves also revealed the increase in event rates in the CKD group (log-rank test P<0.001). By univariate Cox regression analysis, age, smoking, LA dimension, LVMI, and the presence of CKD were significantly associated with the occurrence of AF during follow-up. Among these possible predictors, older age (HR 1.63 /10 years, P<0.001) and the presence of CKD (HR 2.25, P=0.004) were independent determinants for the onset of AF in multivariate analysis. The present study demonstrated that the complication of CKD in hypertensive patients was a powerful predictor of new-onset AF, independently of LV hypertrophy and LA dilatation. Our findings may provide a new aspect in considering the cardiorenal association in hypertensive diseases.

scholarly journals P0252TROPONIN T AND LEFT ATRIAL VOLUME INDEX ARE ASSOCIATED WITH THE OCCURRENCE OF NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4-5

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Markus Hakamäki ◽  
Tapio Hellman ◽  
Roosa Lankinen ◽  
Niina Koivuviita ◽  
Jussi Pärkkä ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Stage 4 ◽  
Ckd Stage ◽  
New Onset

Abstract Background and Aims Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and often co-existing conditions. However, little is known on the prevalence and incidence of AF in patients with CKD stage 4-5. Method We prospectively recruited 210 consecutive non-dialysis patients with CKD stage 4-5 between 2013 and 2017. Follow-up data on AF occurrence as well as baseline medical history, laboratory tests and echocardiography were collected. Results At baseline, mean age was 62 years, 73/210 (34.8%) of the participants were female, mean estimated glomerular filtration rate was 12.8ml/min and 41/210 (19.5%) patients had a prior diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF was detected in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition, most commonly severe infection or surgery, and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age &gt;60 years (HR 4.27, CI95% 1.57-11.64, p&lt;0.01), elevated troponin T (TnT) &gt;50ng/l (HR 3.61, CI95% 1.55-8.37, p&lt;0.01) and left atrial volume index (LAVI) &gt;30ml/m2 (HR 4.82, CI95% 1.11-21.00, p=0.04) independently predicted the occurrence of new-onset AF. Furthermore, the predictive effect of the covariates was cumulative (Figure 1). Conclusion The incidence rate of AF was remarkably high in this prospective study on patients with CKD stage 4-5. Elevated TnT and increased LAVI are associated with the occurrence of new-onset AF in patients with severe CKD.

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