atrial fibrillation in patients on haemodialysis in andalusia. prevalence, clinical profile and therapeutic management

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ID: 259313
2018
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Abstract
Atrial fibrillation (AF) represents an important social and healthcare problem. There is wide variability in the prevalence of this arrhythmia in studies analysing patients on haemodialysis (HD). Objective: To investigate the prevalence, clinical profile and therapeutic management of patients with AF on HD in Andalusia. Methods: We asked the public healthcare system of Andalusia to provide us with the number of patients who were being treated with HD. We asked attending nephrologists from all hospital and outpatient centers in 5 of the 8 Andalusian provinces to perform an electrocardiogram and to fill out a questionnaire on patients selected by simple random sampling. Results: A total of 2348 patients were being treated with HD in the 5 provinces included in the study. The estimated sample size was 285 patients. We obtained an electrocardiogram and information from 252 patients (88.4%); mean age 65.3 ± 16 years; 40.9% women. Sixty-three patients (25%) had AF. Of these, 36 (14.3%) had AF in the recorded ECG and in the rest it had been documented previously. In the multivariate analysis, older age (OR: 1.071; 95% CI: 1.036–1.107; p = 0.000) and greater time on HD (OR: 1.009; 95% CI: 1.004–1.014; p = 0.000) were independently associated with the presence of AF. Of the patients with AF, 41.3% were on anticoagulant treatment at the time of the study; and 41.2% were on antiplatelet agents. Conclusions: AF in dialysis units is an important finding. Establishing the risk–benefit ratio of anticoagulant treatment constitutes a real challenge. Well-designed clinical trials are pivotal in order to define the rational use of antithrombotic drugs. Resumen: La fibrilación auricular (FA) es un importante problema social y sanitario. Existe una amplia variación en la prevalencia de esta arritmia en los estudios que analizan a los pacientes en hemodiálisis (HD). Objetivo: Investigar la prevalencia, perfil clínico y manejo terapéutico de los pacientes con FA en HD en Andalucía. Métodos: Solicitamos al sistema sanitario público de Andalucía el número de pacientes que estaban siendo tratados con HD. Pedimos a los nefrólogos responsables de todos los centros hospitalarios y extrahospitalarios de 5 de las 8 provincias de Andalucía que realizaran un electrocardiograma y cumplimentaran un cuestionario en pacientes seleccionados por un muestreo aleatorizado simple. Resultados: Estaban en HD 2.348 pacientes en las 5 provincias incluidas. El tamaño muestral estimado fue 285 pacientes. Obtuvimos electrocardiograma e información de 252 (88,4%). Edad media 65,3 ± 16 años; 40,9% mujeres. Tenían FA 63 pacientes (25%). De estos, 36 (14,3%) tenían FA en el registro realizado y en el resto había sido documentada previamente. En el análisis multivariante, mayor edad (OR: 1,071; IC 95%: 1,036-1,107; p = 0,000) y mayor tiempo en HD (OR: 1,009; IC 95%:1,004-1,014; p = 0,000) se asociaron de forma independiente con la FA. De los pacientes con FA, el 41,3% estaban en tratamiento anticoagulante en el momento del estudio y el 41,2% con antiagregantes. Conclusiones: La FA en las unidades de diálisis es un importante hallazgo. Establecer la relación riesgo-beneficio del tratamiento anticoagulante constituye un auténtico reto. Son necesarios ensayos clínicos bien diseñados para establecer el uso racional del tratamiento antitrombótico. Keywords: End-stage chronic kidney failure, Haemodialysis, Atrial fibrillation, Antithrombotic therapy, Palabras clave: Insuficiencia renal crónica terminal, Hemodiálisis, Fibrilación auricular, Tratamiento antitrombótico
Reference Key
perales2018nefrologaatrial Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Carmen Sánchez Perales;Teresa Vázquez Sánchez;Daniel Salas Bravo;Sonia Ortega Anguiano;Eduardo Vázquez Ruiz de Castroviejo
Journal demiryolu mühendisliği
Year 2018
DOI
DOI not found
URL
http://www.sciencedirect.com/science/article/pii/S2013251418300166
Keywords
diseases of the genitourinary system urology

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