Related Experiment Video
Updated: Jun 28, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Non-valvular atrial fibrillation in patients on peritoneal dialysis, prevalence, treatment and professionals involved
Elisa Perez-Bernat1, M ª Angeles Viñas2, Manel Vera3
1Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Insights
Patients on peritoneal dialysis frequently have atrial fibrillation and receive oral anticoagulation. However, cardiologists often manage treatment, highlighting a need for greater nephrologist involvement in managing these patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Atrial fibrillation (AF) is a common arrhythmia in chronic kidney disease (CKD).
- Oral anticoagulation (OAC) is crucial for preventing thromboembolic events in AF patients.
- Limited evidence exists on OAC's risk-benefit in CKD stage 5 patients on peritoneal dialysis (PD).
Purpose of the Study:
- To determine the prevalence of non-valvular atrial fibrillation (NVAF) in PD patients.
- To investigate the OAC treatment patterns and professionals involved in managing NVAF in PD patients.
- To identify gaps in care and the need for nephrologist involvement.
Main Methods:
- A descriptive analysis was conducted using a survey distributed to Spanish PD units.
- Data from 1,403 PD patients were analyzed.
- Prevalence of NVAF, OAC use, and risk assessment practices were assessed.
Main Results:
- 13.2% of PD patients (186/1403) had NVAF.
- OAC, including vitamin K antagonists and direct oral anticoagulants, is frequently prescribed.
- Cardiologists primarily assessed thromboembolic and bleeding risks (60%) and prescribed OAC (47% alone, 43% in consensus).
Conclusions:
- PD patients exhibit a significant prevalence of NVAF.
- Current OAC practices indicate a need for enhanced training and involvement of nephrologists in AF management within this population.
- Standardized risk assessment and multidisciplinary care are essential for optimizing OAC therapy in PD patients.
Abstract:
Atrial fibrillation is the most frequent chronic arrhythmia in patients with chronic kidney disease. Oral anticoagulation with vitamin K antagonists and now direct oral anticoagulants have been and are the fundamental pillars for the prevention of thromboembolic events. However, there are no randomized clinical trials on the risk-benefit profile of oral anticoagulation in patients with chronic kidney disease stage 5 on peritoneal dialysis and there is little evidence in the literature in this population. The objective of our study was to know the prevalence, treatment and professionals involved in the management of atrial fibrillation in peritoneal dialysis patients. For this purpose, we performed a descriptive analysis through a survey sent to different peritoneal dialysis units in Spain. A total of 1,403 patients on peritoneal dialysis were included in the study, of whom 186 (13.2%) had non-valvular atrial fibrillation. In addition, the assessment of the scores of thromboembolic and bleeding risks for the indication of oral anticoagulation was mainly carried out by the cardiologist (60% of the units), as well as its prescription (cardiologist 47% or in consensus with the nephrologist 43%). In summary, patients on peritoneal dialysis have a remarkable prevalence of non-valvular atrial fibrillation. Patients frequently receive oral anticoagulation with vitamin K antagonists, as well as direct oral anticoagulants. The data obtained regarding the scores used for the assessment of thromboembolic and bleeding risk, treatment and involvement by Nephrology indicates that there is a need for training and involvement of the nephrologist in this pathology.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:22Heart Failure Drugs: Diuretics
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...