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Clinical characteristics and outcomes of dialysis patients with atrial fibrillation: the Fushimi AF Registry

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Abstract

Atrial fibrillation (AF) is common in dialysis patients. However, clinical characteristics and outcomes of dialysis patients with AF are poorly understood. The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available for 3713 patients with a median follow-up of 2.8 years. We compared clinical characteristics and outcomes between the dialysis group (n = 92; 2.5 %) and others. The dialysis group had more various co-morbidities, with a mean CHADS2 score of 2.5, and the rate of warfarin prescription was 38 %. The annual incidence rates of stroke or systemic embolism (SE), major bleeding, and all-cause death in the dialysis group were 4.0, 5.1, and 20.9 per 100 person-years, respectively. There was no significant difference in the incidence rate of stroke/SE between the dialysis group and the non-dialysis group [hazard ratio (HR) 1.74 (95 % confidence interval (CI) 0.74–3.42)]. The incidence rates of major bleeding, all-cause death, and the composite of stroke/SE and all-cause death in the dialysis group were higher than those in the non-dialysis group [major bleeding: HR 3.09 (95 % CI 1.46–5.72), all-cause death: HR 3.51 (95 % CI 2.48–4.81), the composite of stroke/SE and all-cause death: HR 2.99 (95 % CI 2.15–4.05)]. Among dialysis patients, warfarin did not affect major clinical events including stroke/SE, bleeding or all-cause death. Among AF patients, those receiving dialysis showed higher incidence of major bleeding and all-cause death compared with non-dialysis patients, but the risk of stroke/SE was not particularly high.

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Acknowledgments

We sincerely appreciate the help of all of the institutions participating in the registry and the clinical research coordinators (Shinagawa T, Mitamura M, Fukahori M, Kimura M, Fukuyama M, Kamata C).

Working group members

The following is a list of the institutions participating in the registry.

Chief investigator: Akao M (National Hospital Organization Kyoto Medical Center).

Vice-chief investigator: Chun YH (Ijinkai Takeda General Hospital).

Steering committee: Esato M (Ijinkai Takeda General Hospital), Abe M (National Hospital Organization Kyoto Medical Center), Tsuji H (Tsuji Clinic), Furuke K (Furuke Clinic).

Statistical analysis: Wada H (National Hospital Organization Kyoto Medical Center).

Coordinator: Ogawa T (Ogawa Medical Office), Tasato H (Tasato Clinic), Taniguchi Y (Taniguchi Clinic), Nishikawa M (Nishikawa Clinic), Furukawa K (Furukawa Medical Clinic), Kawai C, Hashimoto T, Kanda M (Ijinkai Takeda General Hospital), Tsukahara T, Fukuda S, Nakamura M, Ito T, Hasegawa K (National Hospital Organization Kyoto Medical Center).

Clinical event committee: Kawabata Y, Yasuda K, Kameyama K (National Hospital Organization Kyoto Medical Center).

Participating institutions: Department of Cardiology, National Hospital Organization Kyoto Medical Center (Akao M, Abe M, Ogawa H, Masunaga N, Iguchi M, Ishii M, Unoki T, Takabayashi K, Hamatani Y, Yamashita Y, Takagi D, Niki S, An Y, Tezuka Y, Osakada G, Nakashima Y, Kanasaki M, Nakano T, Funatsu J, Nishio M, Takenaka Y); Department of Arrhythmia, Ijinkai Takeda General Hospital (Chun YH, Esato M, Kida Y, Nishina N); Koujinkai Oshima Hospital (Terada K); Divison of Translational Research, National Hospital Organization Kyoto Medical Center (Hasegawa K, Wada H); Kanai Hospital (Nishio M, Kamiya Y, Abe M, Ishii M); Tsuji clinic (Tsuji H); Furukawa Medical Clinic (Furukawa K); Nishikawa Clinic (Nishikawa M); Taniguchi Clinic (Taniguchi Y); Gushiken Clinic (Gushiken T); Fushimi Shimizu Hospital (Hirata Y); Yoda Clinic (Yoda J); Tasato Clinic (Tasato H); Ogawa Medical Office (Ogawa T); Saiwai Hospital (Wakatsuki Y, Yahata M, Higashitani N); Itoh Hemodialysis Clinic (Itoh H); Itoh Clinic (Itoh H, Ohmori Y); Ryokuhoukai Tsuji Clinic (Tsuji K); Kitamura Clinic (Kitamura S); Izumikawa Clinic (Izumikawa F); Hirota Clinic (Hirota N); Kyomachi-Oota Clinic (Oota K); Kouseikai Rehabilitation Clinic (Kou K); Inariyama Hospital (Tanaka T, Iguchi M); Matsushita Clinic (Matsushita N); Kitani Clinic (Kitani K); Kimura Clinic (Kimura F); Hayashi Clinic (Hayashi S); Handa Clinic (Handa S); Soseikai General Hospital (Hasegawa S, Kono T, Otsuka K, Soyama A, Okamoto J, Nakai Y); Asamoto Clinic (Asamoto H); Sugano Clinic (Tanaka H, Murata T); Kyoto Ohashi General Hospital (Kayawake S, Kinoshita Y); Furuke Clinic (Furuke K); Kanehisa Clinic (Asano N); Tahara Clinic (Tahara K); Matsumoto Medical Office (Matsumoto K); Kuroda Clinic (Kuroda O); Ochiai Clinic (Ochiai K, Ochiai J); Fujii Clinic (Fujii M); Kurihara Clinic (Kurihara M); Kuzuyama Clinic (Ito A); Kenkokai Fushimi Clinic (Totsuzaki S); Nakayama Orthopedic Clinic (Nakayama H); Department of Cardiovascular Medicine, Ijinkai Takeda General Hospital (Kawai C, Hashimoto T, Kakio T, Watanabe C, Takeda S, Sasaki Y, Shirasawa K, Beppu K, Inoue T, Shirasaka A, Doi T); Tatsumi Clinic (Ueda T); Oishi Clinic (Oishi M); Koizumi Clinic (Kasahara A); Kishida Clinic (Kishida Su, Kishida Sa); Shibata Clinic (Shibata M); Shimizu Clinic (Shimizu J); Shirasu Clinic (Shirasu M); Fujinokai Clinic (Tateishi S); Tsukuda Clinic (Tsukuda N); Shinseikai Tsuji Clinic (Tsuji K); Nishi Clinic (Nishi T); Nishimura Clinic (Nishimura S); Haba Clinic (Haba T); Higashimae Clinic (Higashimae R); Fujimori Clinic (Fujimori C); Hotta Clinic (Hotta T); Matsui Clinic (Matsui H, Matsui H); Shadan Matsumoto Clinic (Matsumoto H); Maruo Clinic (Maruo N); Misu Clinic (Mikami M); Mekata Clinic (Mekata H); Mori Pediatric Clinic (Mori H); Wakabayashi Clinic (Wakabayashi M); Nakatsugawa Clinic (Sasaki Z); Shiseikai Nishimura Clinic (Nishimura S); Yuge Eye Clinic (Yuge K); Gokita Hospital (Haruta M); Soseikai Clinic (Tsuda E); Toujinkai Hospital (Nishimura M); Kouno Clinic (Kouno T, Kouno Y); Matsumura Clinic (Matsumura S); Fujita Clinic (Fujita A); Takayasu Clinic (Takayasu F, Takayasu S), Yano Clinic (Yano Y), Niki Clinic (Niki S), Hasegawa Meiando Clinic (Hasegawa S), Watanabe Medical Clinic (Watanabe T).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Yugo Yamashita

  2. Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan

    Daisuke Takagi, Moritake Iguchi, Nobutoyo Masunaga, Hisashi Ogawa, Mitsuru Abe & Masaharu Akao

  3. Division of Heart Failure, National Cerebral and Cardiovascular Center, Osaka, Japan

    Yasuhiro Hamatani

  4. Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan

    Masahiro Esato & Yeong-Hwa Chun

  5. Itoh Hemodialysis Clinic, Kyoto, Japan

    Hitoshi Itoh

  6. Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan

    Masato Nishimura

  7. Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Hiromichi Wada & Koji Hasegawa

Authors
  1. Yugo Yamashita
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  2. Daisuke Takagi
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  3. Yasuhiro Hamatani
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  4. Moritake Iguchi
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  13. Mitsuru Abe
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  14. Masaharu Akao
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Corresponding author

Correspondence to Masaharu Akao.

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Conflict of interest

Lecture fees: Masaharu Akao (Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim and Bayer Healthcare). All other authors have declared no competing interest.

Sources of funding

The Fushimi AF Registry is supported by research funding from Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Astellas Pharma, AstraZeneca, Daiichi-Sankyo, Novartis Pharma, MSD, Sanofi-Aventis and Takeda Pharmaceutical. This research is partially supported by the Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development, AMED (15656344).

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Yamashita, Y., Takagi, D., Hamatani, Y. et al. Clinical characteristics and outcomes of dialysis patients with atrial fibrillation: the Fushimi AF Registry. Heart Vessels 31, 2025–2034 (2016). https://doi.org/10.1007/s00380-016-0818-x

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