Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy
Open accessAbstract
Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we determined incidence, prevalence, and outcomes among hemodialysis patients with atrial fibrillation. Cox proportional hazards models, to identify associations with newly diagnosed atrial fibrillation and clinical outcomes, were stratified by country and study phase and adjusted for descriptive characteristics and comorbidities. Of 17,513 randomly sampled patients, 2188 had preexisting atrial fibrillation, with wide variation in prevalence across countries. Advanced age, non-black race, higher facility mean dialysate calcium, prosthetic heart valves, and valvular heart disease were associated with higher risk of new atrial fibrillation. Atrial fibrillation at study enrollment was positively associated with all-cause mortality and stroke. The CHADS2 score identified approximately equal-size groups of hemodialysis patients with atrial fibrillation with low (less than 2) and higher risk (more than 4) for subsequent strokes on a per 100 patient-year basis. Among patients with atrial fibrillation, warfarin use was associated with a significantly higher stroke risk, particularly in those over 75 years of age. Our study shows that atrial fibrillation is common and associated with elevated risk of adverse clinical outcomes, and this risk is even higher among elderly patients prescribed warfarin. The effectiveness and safety of warfarin in hemodialysis patients require additional investigation.
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Warfarin use was associated either with a neutral or increased risk of stroke in database analyses of patients on dialysis, including a population-based analysis in Canada (adjusted HR for stroke 1.14; 95% CI 0.78-1.67, adjusted HR for bleeding 1.44; 95% CI 1.13-1.85).
“Warfarin use was associated either with a neutral or increased risk of stroke in database analyses of patients on dialysis, [419][420][421] including a population-based analysis in Canada (adjusted HR for stroke 1.14; 95% CI 0.78-1.67,adjusted HR for bleeding 1.44; 95% CI 1.13-1.85).422”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [419]
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- Authors
- Wizemann, V., Tong, L., Satayathum, S., Disney, A., Akiba, T., Fissell, R. B., Kerr, P. G., Young, E. W., & Robinson, B. M.
- Affiliations
- Arbor Research Collaborative for Health (US)
- Queen Elizabeth Hospital (AU)
- Tokyo Women's Medical University (JP)
- Cleveland Clinic (US)
- Monash Medical Centre (AU)
- United States Department of Veterans Affairs (US)
- University of Michigan (US)
- Corresponding author
- Robinson, Bruce M.
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 77
- Issue
- 12
- Pages
- 1098-1106
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W1981440884
- Cited by
- 408
- References
- 52
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 19 · 2023: 15 · 2022: 20 · 2021: 21 · 2020: 30 · 2019: 21 · 2018: 32 · 2017: 44 · 2016: 38 · 2015: 34 · 2014: 25 · 2013: 35 · 2012: 29
- FWCI
- 18.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Kyowa Hakko Kirin
- Sanofi Genzyme
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Blood properties and coagulation
- Keywords
- atrial fibrillation, hemodialysis, anticoagulation, warfarin, stroke risk, all-cause mortality, CHADS2 score, dialysate calcium, prosthetic heart valves, valvular heart disease, elderly patients, risk factors, DOPPS
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Data Collection, Renal Dialysis, Humans, Middle Aged, Mortality, Warfarin, Incidence, Prevalence, Treatment Outcome, Age Distribution, Stroke, Renal Insufficiency
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