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The occurrence of atrial fibrillation in dialysis patients and its association with left atrium volume before and after dialysis

  • Nephrology - Original Paper
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Abstract

Purpose

Atrial fibrillation is a serious problem, especially in patients on dialysis. The prevalence of AF in this group of patients is higher than in general population and associated with increased mortality. The aim of this study was to assess the risk of the occurrence of atrial fibrillation related to intradialysis hypotension and left atrium volume enlargement associated with dialysis. The influence of dialysis session on: E/E′, V LA, E/A, E′, V RA and the width of inferior vena cava of RV was analyzed.

Methods

This study included 40 patients on hemodialysis. Echocardiographic examination was performed to assess heart condition and function, the presence of LVH and systolic and diastolic function disturbances, LV mass, LA size, LAV, RAV, E/A, E′, E/E, ejection fraction in all patients before and after dialysis. Moreover, all patients had ECG Holter continuously recording heart’s rhythm before and after dialysis to assess the occurrence of atrial fibrillation related to dialysis session.

Results

The analysis of differences in echocardiographic parameters before and after dialysis demonstrated significantly greater left atrium volume, right atrium volume, width of inferior vena cava and e’ parameter before dialysis in comparison with post-dialysis state. Significantly higher incidence of AF after dialysis was seen. Volume of left atrium exceeding 32 mm (cutoff value) was observed significantly more often in patients before dialysis. No association was observed between left ventricle mass and left atrium volume.

Conclusions

The dialysis procedure may be a trigger for atrial fibrillation and thus AF preventive measures should be introduced in dialysis patients.

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References

  1. Fabbian F, Catalano C, Lambertini D, Tarroni G, Bordin V, Squerzanti R, Gilli P, Di Landro D, Cavagna R (2000) Clinical characteristics associated to atrial fibrillation in chronic hemodialysis patients. Clin Nephrol 54:234–239

    CAS  PubMed  Google Scholar 

  2. Genovesi S, Pogliani D, Faini A, Valsecchi MG, Riva A, Stefani F, Acquistapace I, Stella A, Bonforte G, DeVecchi A, DeCristofaro V, Buccianti G, Vincenti A (2005) Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. Am J Kidney Dis 46:897–902

    Article  PubMed  Google Scholar 

  3. Ruo B, Capra AM, Jensvold NG, Go AS (2004) Racial variation in the prevalence of atrial fibrillation among patients with heart failure: the epidemiology, practice, outcomes, and costs of heart failure (EPOCH) study. J Am Coll Cardiol 43:429–435

    Article  PubMed  Google Scholar 

  4. Winkelmayer WC, Patrick AR, Liu J, Brookhart MA, Setoguchi S (2011) The increasing prevalence of atrial fibrillation among hemodialysis patients. J Am Soc Nephrol 22:349–357

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bellasi A, Veledar E, Ferramosca E, Ratti C, Block G, Raggi P (2008) Markers of vascular disease do not differ in black and white hemodialysis patients despite a different risk profile. Atherosclerosis 197:242–249

    Article  CAS  PubMed  Google Scholar 

  6. Vazquez E, Sanchez-Perales C, Garcia-Garcia F, Castellano P, Garcia-Cortes MJ, Liebana A, Lozano C (2009) Atrial fibrillation in incident dialysis patients. Kidney Int 76:324–330

    Article  PubMed  Google Scholar 

  7. Stritzke J, Markus MR, Duderstadt S, Lieb W, Luchner A, Doring A, Keil U, Hense HW (2009) The aging process of the heart: obesity is the main risk factor for left atrial enlargement during aging: the MONICA/KORA (monitoring of trends and determinations in cardiovascular disease/cooperative research in the region of Augsburg) study. J Am Coll Cardiol 54(21):1982–1989

    Article  PubMed  Google Scholar 

  8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463

    Article  PubMed  Google Scholar 

  9. Tani T, Tanabe K, Ono M et al (2004) Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 17:644–648

    Article  PubMed  Google Scholar 

  10. Pritchett AM, Jacobsen SJ, Mahoney DW et al (2003) Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 41:1036–1043

    Article  PubMed  Google Scholar 

  11. Stefanadis C, Dernellis J, Toutouzas P (1999) Evaluation of the left atrial performance using acoustic quantification. Echocardiography 16:117–125

    Article  PubMed  Google Scholar 

  12. Kagawa K, Arakawa M, Miwa H et al (1994) Left atrial function during left ventricular diastole evaluated by left atrial angiography and left ventriculography. J Cardiol 24:317–325

    CAS  PubMed  Google Scholar 

  13. Klepacka J (2004) Acute complication of hemodialysis. Renal replacement therapy in medical practice, II eddiotion. MAK-media, Gdańsk (in Polish)

    Google Scholar 

  14. Buiten MS, de Bie MK, Rotmans JI, Gabreëls BA, van Dorp W, Wolterbeek R, Trines SA, Schalij MJ, Jukema JW, Rabelink TJ, van Erven L (2014) The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients. Heart 100:685–690

    Article  CAS  PubMed  Google Scholar 

  15. Wanner C, Krane V, Marz W (2005) Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 353(3):238–248

    Article  CAS  PubMed  Google Scholar 

  16. Fellstrom BC, Jardine AG, Schmieder RE (2009) Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 360(14):1395–1407

    Article  CAS  PubMed  Google Scholar 

  17. Patel RK, Jardine AGM, Mark PB, Cunningham AF, Steedman T, Powell JR, McQuarrie EP, Stevens KK, Dargie HJ, Jardine AG (2010) Association of left atrial volume with mortality among ESRD patients with left ventricular hypertrophy referred for kidney transplantation. Am J Kidney Dis 55(6):1088–1096

    Article  PubMed  PubMed Central  Google Scholar 

  18. Parfrey PS, Harnett JD, Griffiths SM (1990) The clinical course of left ventricular hypertrophy in dialysis patients. Nephron 55(2):114–120

    Article  CAS  PubMed  Google Scholar 

  19. Schmidt BMW, Schmieder RE (2003) Aldosterone-induced cardiac damage focus on blood pressure independent effects. Am J Hypertens 16:80–86

    Article  CAS  PubMed  Google Scholar 

  20. Genovesi S, Vincenti A, Rossi E et al (2008) Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. Am J Kidney Dis 51:255–262

    Article  PubMed  Google Scholar 

  21. Hassanin N, Alkemar A (2016) Detection of left atrium myopathy using two-dimensional speckle tracking echocardiography in patients with end-stage renal disease on dialysis therapy. Echocardiography 33:233–241

    Article  PubMed  Google Scholar 

  22. Zaza A (2009) Serum potassium and arrhythmias. Europace 11:421–422

    Article  PubMed  Google Scholar 

  23. Buiten MS, de Bie MK, Rotmans JI, Gabreëls BA, van Dorp W, Wolterbeek R, Trines SA, Schalij MJ, Jukema JW, Rabelink TJ, van Erven L (2014) The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients. Heart 100(9):685–690

    Article  CAS  PubMed  Google Scholar 

  24. Braunschweig F, Kjellstrom B, Soderhall M et al (2006) Dynamic changes in right ventricular pressures during haemodialysis recorded with an implantable haemodynamic monitor. Nephrol Dial Transplant 21:176–183

    Article  PubMed  Google Scholar 

  25. Kjellstrom B, Braunschweig F, Lofberg E et al (2009) Changes in right ventricular pressures between hemodialysis sessions recorded by an implantable hemodynamic monitor. Am J Cardiol 103:119–123

    Article  PubMed  Google Scholar 

  26. Bleyer AJ, Hartman J, Brannon PC et al (2006) Characteristics of sudden death in hemodialysis patients. Kidney Int 69:2268–2273

    Article  CAS  PubMed  Google Scholar 

  27. Zoccali C, Mallamaci F, Parlongo S et al (2002) Plasma norepinephrine predicts survival and incident cardiovascular events in patients with end-stage renal disease. Circulation 105:1354–1359

    Article  CAS  PubMed  Google Scholar 

  28. Koomans HA, Blankestijn PJ, Joles JA (2004) Sympathetic hyperactivity in chronic renal failure: a wake-up call. J Am Soc Nephrol 15:524–537

    Article  PubMed  Google Scholar 

  29. Tanaka A, Inaguma D, Shinjo H, Murata M, Takeda A (2016) Aichi cohort study of prognosis in patients newly initiated into dialysis (AICOPP) study group: presence of atrial fibrillation at the time of dialysis initiation is associated with mortality and cardiovascular events. Nephron 132:86–92

    Article  CAS  PubMed  Google Scholar 

  30. Zapolski T, Jaroszyński A et al (2012) Left atrial volume index as a predictor of ventricle repolarization abnormalities in adult dialyzed patients. Hemodial Int 16:220–232

    Article  PubMed  Google Scholar 

  31. Tripepi G, Benedetto FA, Mallamaci F, Tripepi R, Malatino L, Zoccali C (2007) Left atrial volume monitoring and cardiovascular risk in patients with end-stage renal disease: a prospective cohort study. J Am Soc Nephrol 18:1316–1322

    Article  PubMed  Google Scholar 

  32. Tsang TS, Barnes ME, Gersh BJ et al (2003) Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol 42(7):1199–1205

    Article  Google Scholar 

  33. Douglas PS (2003) The left atrium. A biomarker of chronic diastolic dysfunction and cardiovascular disease risk. J Am Coll Cardiol 42:1206–1207

    Article  PubMed  Google Scholar 

  34. Zapolski T, Jaroszyński A et al (2010) Function of left atrium in end-stage renal disease patients without clinical symptoms of cardiovascular disease. Pol Cardiol 68(3):S277

    Google Scholar 

  35. Kim SJ, Han SH, Park JT et al (2011) Left atrium volume is an independent predictor of mortality in CAPD patients. Nephrol Dial Transplant 26:3732–3739

    Article  PubMed  Google Scholar 

  36. Losi MA, Memoli B, Contaldi C et al (2010) Myocardial fibrosis and diastolic dysfunction in patients on chronic hemodialysis. Nephrol Dial Transplant 25:1950–1954

    Article  PubMed  Google Scholar 

  37. Kizer JR, Bella JN, Palmieri V et al (2006) Left atrium diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults. Am Heart J 151:412–418

    Article  PubMed  Google Scholar 

  38. Malik J, Lachmanova J, Kudlicka J, Rocinova K, Valerianova A, Bartkova M, Tesar V (2016) Left atrial dysfunction in end-stage renal disease patients treated by hemodialysis. Nephron 133(3):169–174

    Article  CAS  PubMed  Google Scholar 

  39. Dernellis JM, Stefanadis CI, Zacharoulis AA, Toutouzas PK (1998) Left atrial mechanical adaptation to long-standing hemodynamic loads based on pressure-volume relations. Am J Cardiol 81:1138–1143

    Article  CAS  PubMed  Google Scholar 

  40. Palecek T, Skalicka L, Lachmanova J, Tesar V, Linhart A (2008) Effect of preload reduction by hemodialysis on conventional and novel echocardiographic parameters of left ventricular structure and function. Echocardiography 25:162–168

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland

    Beata Franczyk, Piotr Bartnicki & Jacek Rysz

  2. Department of Nephrology, Hypertension and Family Medicine, WAM Teaching Hospital, Zeromskiego 113, 90-549, Lodz, Poland

    Anna Gluba-Brzózka

Authors
  1. Beata Franczyk
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  2. Anna Gluba-Brzózka
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  3. Piotr Bartnicki
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  4. Jacek Rysz
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Corresponding author

Correspondence to Anna Gluba-Brzózka.

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Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Medical University of Lodz (no. RNN/147/16/KE of 10 May 2016).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Franczyk, B., Gluba-Brzózka, A., Bartnicki, P. et al. The occurrence of atrial fibrillation in dialysis patients and its association with left atrium volume before and after dialysis. Int Urol Nephrol 49, 1071–1077 (2017). https://doi.org/10.1007/s11255-017-1506-1

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  • DOI: https://doi.org/10.1007/s11255-017-1506-1

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