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Impact of atrial fibrillation on the risk of ischemic stroke in patients on hemodialysis: BOREAS-HD3 Study

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Abstract

Background

Atrial fibrillation (AF) is an established risk factor for ischemic stroke in a general population. However, its impact in patients on hemodialysis (HD), a group with a high risk for stroke, is still controversial. Here we examined this issue in a Japanese cohort.

Methods

This study was designed as a multicenter cohort study. HD patients (n = 1,067) were enrolled from 22 institutes in January 2009 and followed up for 3 years. Patients with missing data (n = 196) or kidney transplantation (n = 4) were excluded, and 867 patients contributed to the analysis of the risk of new-onset of ischemic stroke.

Results

At baseline, AF was observed in 123 patients (14.2%, AF group) and not in the others (n = 744: 85.8%, non-AF group). During a follow-up period of 31.3 months, the cumulative incidence rate for ischemic stroke was significantly higher in the AF group than in the non-AF group (6.5% vs. 2.9%, p < 0.05). In Cox regression analysis, AF was a significant independent risk factor for new-onset of ischemic stroke after adjustment for age, sex, prior history of ischemic stroke, use of warfarin, dialysis vintage, comorbidity of diabetic nephropathy, and interdialytic weight gain (hazard ratio 2.17–2.68).

Conclusion

Present analyses using comprehensive adjustment for multiple confounders, including prior history of ischemic stroke, indicated that AF independently increases the risk of new-onset of ischemic stroke by more than twofold in Japanese HD patients.

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Acknowledgements

We thank for all members of BOREAS-HD Study Investigators. The consortium includes Masatada Fukuoka, Koichi Hasegawa, Manabu Hayashi, Toshiya Ishiguro, Akira Ishimoto, Yosuke Itoh, Toshihiro Iwamoto, Hironori Kobayashi, Hiroshi Kobayashi, Atsushi Konno, Setsuko Kuroda, Tomoaki Matsumoto, Tamaki Matsumoto, Hiroya Mukai, Takahiro Nishitani, Fumio Obara, Toru Otomo, Takashi Sakamoto, Niro Sawai, Katsuo Suzuki, Yoshitoki Takagawa, Hideki Takizawa, Kazushi Tanaka, Nobuhiko Togashi, Takaaki Torii, Daisuke Yoshida, Mayumi Yoshihara and Atsushi Wada.

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Author notes

  1. Ayumu Kimura and Marenao Tanaka equally contributed to this work.

Authors and Affiliations

  1. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan

    Ayumu Kimura, Marenao Tanaka, Norihito Moniwa, Arata Osanami, Koki Abe, Daisuke Miyamori, Yufu Gocho, Satoru Shibata, Makoto Terasawa, Yusuke Okazaki, Tomohisa Yamashita, Masayuki Koyama, Masato Furuhashi, Hirofumi Ohnishi & Tetsuji Miura

  2. Department of Nephrology, Teine Keijinkai Hospital, Sapporo, Japan

    Koki Abe

  3. Department of Internal Medicine, Cardiology and Diabetology, Steel Memorial Muroran Hospital, Muroran, Japan

    Satoru Shibata & Yusuke Okazaki

  4. Department of Nephrology, Asahikawa Red Cross Hospital, Asahikawa, Japan

    Tomohisa Yamashita

  5. Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan

    Masayuki Koyama & Hirofumi Ohnishi

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  1. Ayumu Kimura
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  15. Tetsuji Miura
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Contributions

Marenao Tanaka (M.T.) conceived this study, and M.T., Tomohisa Yamashita (T.Y.) and Masayuki Koyama (M.K.) designed the study. M.T., T.Y., M.K., Satoru Shibata (S.S.) and Yusuke Okazaki (Y.O.) collected data. Ayumu Kimura (A.K.) and M.T. performed statistical analysis of the data, prepared tables and figures and drafted manuscript. Norihito Moniwa (N.M.), Arata Osanami, Koki Abe, Daisuke Miyamori, Yufu Gocho, Makoto Terasawa, Masato Furuhashi (M.F.), Hirofumi Ohnishi (H.O.) and Tetsuji Miura (T.M.) contributed to interpretation of the data and to finalize the manuscript. H.O. and T.M. supervised the statistical analysis and the entire project, respectively. For authors who moved during the present study, affiliations at the time of commencement of the study and also current affiliations are described.

Corresponding author

Correspondence to Marenao Tanaka.

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All of the authors have declared that no conflicts of interest exist.

Ethical approval

This study was performed in accordance with the guidelines contained within the Declaration of Helsinki and the protocol was licensed by the institutional ethical committee of Sapporo Medical University (number: 21-29).

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Written informed consent was obtained from all of the subjects.

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Kimura, A., Tanaka, M., Moniwa, N. et al. Impact of atrial fibrillation on the risk of ischemic stroke in patients on hemodialysis: BOREAS-HD3 Study. Clin Exp Nephrol 25, 297–304 (2021). https://doi.org/10.1007/s10157-020-01991-9

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  • DOI: https://doi.org/10.1007/s10157-020-01991-9

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