Prevalence of Atrial Fibrillation in Patients With end Stage Renal Disease

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia in patients with end-stage renal disease (ESRD). The coexistence of high thromboembolic and hemorrhagic risks, added to the lack of strong scientific evidence on the safety of anticoagulants in the setting of renal failure, makes this a clinically challenging situation. Objectives: To describe the clinical-demographic profile and prevalence of AF in the population with ESRD undergoing dialysis. Secondary objectives include the assessment of thromboembolic (CHA2 DS2 VASC) and bleeding (HASBLED) risk scores. Methods: Cross-sectional analytical-descriptive study, carried out between January and March 2020. Patients with ESRD were evaluated by means of a medical history questionnaire, physical examination, and 12-lead electrocardiogram. A chi-square (χ2) association test was applied to calculate association between clinical variables and AF, with a significance level of α = 0.05. Results: This study evaluated 295 patients, most of whom were men (170), elderly (63, IQR 53-71), current smokers (130), with associated cardio-endocrine comorbidities. The prevalence of AF was 6.7% (20). Heart failure (HF) (χ2=15.417; p<0.001), age of 65 years or older (χ2=14.584; p<0.001), and anticoagulation (χ2=5.715; p<0.01) were associated with AF. The median CHA2 DS2 VASC and HASBLED was 4 and 3, respectively. Eight patients were taking warfarin and five were receiving apixaban. Conclusion: The prevalence of AF in this study is similar to that reported in other published articles on the subject, and patients were at high risk for cardiovascular outcomes. Non-anticoagulation strategy was commonly adopted due to controversies in the literature as well as the absence of published randomized clinical trials.