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Ruiz-García A, Serrano-Cumplido A, Escobar-Cervantes C, Arranz-Martínez E, Pallarés-Carratalá V. Atrial Fibrillation Prevalence Rates and Its Association with Cardiovascular-Kidney-Metabolic Factors: SIMETAP-AF Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1309. [PMID: 39202590 PMCID: PMC11356659 DOI: 10.3390/medicina60081309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Atrial fibrillation (AF) is the most frequent arrhythmia and the main cause of hospital admissions for cardioembolic stroke. The SIMETAP research project aims to update the prevalence rates of cardiovascular, renal, or metabolic factors and to evaluate their respective associations with factors that could be related. The present study aims to assess the AF prevalence rates in an adult population and its association with cardiovascular-kidney-metabolic (CKM) factors. Materials and Methods: This cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of AF were calculated. The associations of CKM factors with AF were assessed using bivariate and multivariate analysis. Results: The age- and sex-adjusted prevalence rates of AF were 2.9% in the overall adult population, 6.1% in the population aged ≥50 years, and 12.9% in the population aged ≥70 years, with no significant differences by sex. AF prevalence in the population under 50 years of age barely reached 1‰. Heart failure (HF), hypertension, chronic kidney disease (CKD), stroke, low HDL-cholesterol, and prediabetes were independent CKM factors associated with AF in the overall population, as were the same factors, except prediabetes, in the population ≥50 years old (p < 0.001). High or very high vascular risk was present in 92.4% [95% CI: 89.1-95.7]) of the population with AF. Conclusions: The adjusted prevalence rate of AF in the population aged 50 years or older was 6.1%, twice that of the overall adult population and half that of the population aged 70 years or older. The main independent CKM factors associated with AF were HF, stroke, CKD, hypertension, and low HDL-cholesterol.
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Affiliation(s)
- Antonio Ruiz-García
- Lipids and Cardiovascular Prevention Unit, Pinto University Health Centre, 28320 Madrid, Spain;
- Department of Medicine, European University of Madrid, 28005 Madrid, Spain
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Zuin M, Malagù M, Vitali F, Balla C, De Raffele M, Ferrari R, Boriani G, Bertini M. Trends in atrial fibrillation-related mortality in Europe, 2008-2019. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:467-478. [PMID: 38289824 DOI: 10.1093/ehjqcco/qcae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/28/2023] [Accepted: 01/28/2024] [Indexed: 02/01/2024]
Abstract
AIMS Update data regarding the atrial fibrillation (AF)-related mortality trend in Europe remain scant. We assess the age- and sex-specific trends in AF-related mortality in the European states between the years 2008 and 2019. METHODS AND RESULTS Data on cause-specific deaths and population numbers by sex for European countries were retrieved through the publicly available World Health Organization mortality dataset for the years 2008-2019. Atrial fibrillation-related deaths were ascertained when the International Classification of Diseases, 10th Revision code I48 was listed as the underlying cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual % change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 773 750 AF-related deaths (202 552 males and 571 198 females) occurred in Europe. The age-adjusted mortality rate (AAMR) linearly increased from 12.3 (95% CI: 11.2-12.9) per 100 000 population in 2008 to 15.3 (95% CI: 14.7-15.7) per 100 000 population in 2019 [AAPC: +2.0% (95% CI: 1.6-3.5), P < 0.001] with a more pronounced increase among men [AAPC: +2.7% (95% CI: 1.9-3.5), P < 0.001] compared with women [AAPC: +1.7% (95% CI: 1.1-2.3), P < 0.001] (P for parallelism 0.01). Higher AAMR increases were observed in some Eastern European countries such as Latvia, Lithuania, and Poland, while the lower increases were mainly clustered in Central Europe. CONCLUSION Over the last decade, the age-adjusted AF-related mortality has increased in Europe, especially among males. Disparities still exist between Western and Eastern European countries.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Cardiology, Azienda Ospedaliero-Universitaria 'S. Anna', Via Aldo Moro, 8, 44124 Ferrara, Italy
| | - Michele Malagù
- Department of Cardiology, Azienda Ospedaliero-Universitaria 'S. Anna', Via Aldo Moro, 8, 44124 Ferrara, Italy
| | - Francesco Vitali
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Cardiology, Azienda Ospedaliero-Universitaria 'S. Anna', Via Aldo Moro, 8, 44124 Ferrara, Italy
| | - Cristina Balla
- Department of Cardiology, Azienda Ospedaliero-Universitaria 'S. Anna', Via Aldo Moro, 8, 44124 Ferrara, Italy
| | - Martina De Raffele
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Roberto Ferrari
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Matteo Bertini
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Cardiology, Azienda Ospedaliero-Universitaria 'S. Anna', Via Aldo Moro, 8, 44124 Ferrara, Italy
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Heleniak Z, Matusik PT, Undas A. Altered fibrin clot properties are associated with the progression of chronic kidney disease in atrial fibrillation. Thromb Res 2024; 236:14-21. [PMID: 38387299 DOI: 10.1016/j.thromres.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Formation of denser and resistant to lysis fibrin clot networks has been shown in chronic kidney disease (CKD) and atrial fibrillation (AF). We investigated whether such prothrombotic fibrin clot properties are associated with faster progression of CKD in AF patients. MATERIAL AND METHODS We recruited 265 AF patients (men 49.1 %, median age of 64.0 years, median estimated glomerular filtration rate [eGFR] of 77.0 ml/min/1.73 m2), including 137 patients on non-vitamin K antagonist oral anticoagulants (NOACs) (51.7 %) and 109 patients (41.1 %) on vitamin K antagonists (VKAs). At baseline while off anticoagulation, we determined fibrin clot permeability (Ks), and clot lysis time (CLT), along with plasminogen activator inhibitor-1 (PAI-1), endogenous thrombin potential (ETP), and von Willebrand factor (vWF). The kidney function was assessed at baseline and after a median follow-up of 50.0 months. RESULTS During follow-up, a median eGFR decreased by 8.0 (5.0-11.0) ml/min/1.73 m2, 1.8 ml/min/1.73 m2/year and this change correlated with age (R = 0.19, P = 0.002), Ks (R = 0.46, P < 0.0001), and CLT (R = -0.17, P = 0.005), but not ETP, fibrinogen, PAI-1 or vWF. A decrease in eGFR was lower in patients who used NOACs at baseline but not in those who started NOACs during follow-up (n = 101) as compared to the remaining patients. On multiple linear regression analysis, adjusted for age and fibrinogen, baseline Ks, eGFR, hypertension, and NOACs use independently predicted a decrease in eGFR. CONCLUSIONS This study is the first to show that more compact fibrin clot networks may contribute to faster progression of CKD in AF, indicating novel kidney-related harmful effects of prothrombotic clot properties in humans.
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Affiliation(s)
- Zbigniew Heleniak
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Paweł T Matusik
- St. John Paul II Hospital, Kraków, Poland; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Anetta Undas
- St. John Paul II Hospital, Kraków, Poland; Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Lin Y, Chao TF, Tsai ML, Tseng CJ, Wang TH, Chang CH, Lin YS, Yang NI, Chu PH, Hung MJ, Wu VCC, Chen TH. Cardiovascular and renal outcomes in patients with atrial fibrillation and stage 4-5 chronic kidney disease receiving direct oral anticoagulants: a multicenter retrospective cohort study. J Thromb Thrombolysis 2024; 57:89-100. [PMID: 37605063 DOI: 10.1007/s11239-023-02885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 08/23/2023]
Abstract
The role of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and stage 4-5 chronic kidney disease (CKD) is controversial. Electronic medical records from 2012 to 2021 were retrieved for patients with AF and stage 4-5 CKD receiving oral anticoagulants. Patients were separated into those receiving DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) or vitamin K antagonists (VKA). Primary outcomes included ischemic stroke (IS), systemic thrombosis (SE), major bleeding, gastrointestinal bleeding, hemorrhagic stroke, acute myocardial infarction, cardiovascular death, and all-cause death. Renal outcomes included eGFR declines, creatinine doubling, progression to dialysis, and major adverse kidney events (MAKE). The primary analysis was until the end of follow up and the results at 1-year and 2-year of follow ups were also assessed. 2,382 patients (DOAC = 1,047, VKA = 1,335) between 2012 and 2021 with AF and stage 4-5 CKD were identified. The mean follow-up period was 2.3 ± 2.1 years in DOCAs and 2.6 ± 2.3 years in VKA respectively. At the end of follow up, the DOAC patients had significantly decreased SE (subdistribution hazard ratio [SHR] = 0.50, 95% confidence interval [CI] = 0.34-0.73), composite of IS/SE (SHR = 0.78, 95% CI = 0.62-0.98), major bleeding (HR = 0.77, 95% CI = 0.66-0.90), hemorrhagic stroke (HR = 0.52, 95% CI = 0.36-0.76), and composite of bleeding events (SHR = 0.80, 95% CI = 0.69-0.92) compared with VKA patients. The IS efficacy outcome revealed neutral between DOAC and VKA patients (HR = 1.05, 95% CI = 0.79-1.39). In addition, DOAC patients had significantly decreased rates of eGFR decline > 50% (SHR = 0.75, 95% CI = 0.64-0.87), creatinine doubling (SHR = 0.80, 95% CI = 0.67-0.95), and MAKE (SHR = 0.81, 95% CI = 0.71-0.93). In patients with AF and stage 4-5 CKD, use of DOAC was associated with decreased rates of a composite of ischemic stroke/systemic embolism, a composite of bleeding events, and renal events compared to VKA. Efficacy and safety benefits associated with apixaban at standard doses were consistent throughout follow-up.
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Affiliation(s)
- Yuan Lin
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Lung Tsai
- Division of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Chin-Ju Tseng
- Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Te-Hsiung Wang
- Department of Emergency Medicine, Medical Research Institute, Kitano Hospital, Tazuke Kofukai, Osaka, Japan
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yu-Sheng Lin
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ning-I Yang
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
| | - Ming-Jui Hung
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan.
| | - Tien-Hsing Chen
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan.
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
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Morimoto T, Hoshino H, Matsuo Y, Ibuki T, Miyata K, Koretsune Y. Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study. Am J Cardiovasc Drugs 2023; 23:721-733. [PMID: 37847442 PMCID: PMC10625512 DOI: 10.1007/s40256-023-00611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND We previously conducted a retrospective cohort study using chart review of oral anticoagulant-naïve Japanese patients with nonvalvular atrial fibrillation (NVAF) that assessed the risk of major bleeding and stroke/systemic embolism (SE) events of apixaban versus warfarin. METHODS In this subgroup analysis, we compared the risk of major bleeding and stroke/SE events by stratifying patients into four subgroups matched 1:1 using propensity score matching (PSM) according to baseline creatinine clearance (CrCl; mL/min): ≥ 15 to < 30, ≥ 30 to < 50, ≥ 50 to < 80, and ≥ 80. RESULTS Of the 7074 patients in the apixaban group and 4998 in the warfarin group eligible for inclusion in the analysis, 4385 were included in each group after PSM. Incidence rates of major bleeding and stroke/SE events were generally lower with apixaban versus warfarin across the CrCl subgroups. When all patients with a CrCl change of < 0 mL/min per year during the study period (apixaban, n = 3871; warfarin, n = 2635) were stratified into four subgroups based on the magnitude of CrCl decline (median CrCl change [mL/min] per year: - 1.09, - 3.48, - 7.54, and - 36.92 for apixaban, and - 1.10, - 3.65, - 7.85, and - 40.40 for warfarin), the incidence rates of major bleeding and stroke/SE events generally increased with an increasing CrCl decline per year in both groups. CONCLUSIONS In Japanese patients with NVAF, the safety and effectiveness of apixaban and warfarin were consistent across different renal subgroups, including those with severe renal impairment. Our results highlight the importance of monitoring renal function variations over time in patients with NVAF. CLINICALTRIALS GOV IDENTIFIER NCT03765242.
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Affiliation(s)
- Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yukako Matsuo
- Medical Department, Bristol Myers Squibb K.K., Tokyo, Japan
| | | | - Kayoko Miyata
- Medical Department, Bristol Myers Squibb K.K., Tokyo, Japan
| | - Yukihiro Koretsune
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Ruiz-García A, Serrano-Cumplido A, Escobar-Cervantes C, Arranz-Martínez E, Turégano-Yedro M, Pallarés-Carratalá V. Heart Failure Prevalence Rates and Its Association with Other Cardiovascular Diseases and Chronic Kidney Disease: SIMETAP-HF Study. J Clin Med 2023; 12:4924. [PMID: 37568326 PMCID: PMC10419820 DOI: 10.3390/jcm12154924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a major health problem that causes high mortality and hospitalization rates. This study aims to determine the HF prevalence rates in populations aged both ≥18 years and ≥50 years and to assess its association with cardiovascular diseases and chronic kidney disease. METHODS A cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HF were calculated. The associations of renal and cardiometabolic factors with HF were assessed in both populations using univariate, bivariate and multivariate analysis. RESULTS The HF crude prevalence rates were 2.8% (95%CI: 2.4-3.2) in adults (≥18 years), and 4.6% (95%CI: 4.0-5.3) in the population aged ≥ 50 years, without significant differences between males and females in both populations. The age- and sex-adjusted prevalence rates were 2.1% (male: 1.9%; female: 2.3%) in the overall adult population, and 4.5% (male: 4.2%; female: 4.8%) in the population aged ≥ 50 years, reaching 10.0% in the population aged ≥ 70 years. Atrial fibrillation, hypertension, low estimated glomerular filtration rate (eGFR), coronary heart disease (CHD), stroke, sedentary lifestyle, and diabetes were independently associated with HF in both populations. A total of 95.7% (95%CI: 92.7-98.6) of the population with HF had an elevated cardiovascular risk. CONCLUSIONS This study reports that HF prevalence increases from 4.5% in the population over 50 years to 10% in the population over 70 years. The main clinical conditions that are HF-related are sedentary lifestyle, atrial fibrillation, hypertension, diabetes, low eGFR, stroke, and CHD.
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Affiliation(s)
- Antonio Ruiz-García
- Pinto Primary Care Center, Lipids and Cardiovascular Prevention Unit, University Health Centre, 28320 Madrid, Spain;
- Department of Medicine, European University of Madrid, 28005 Madrid, Spain
| | | | | | | | | | - Vicente Pallarés-Carratalá
- Health Surveillance Unit, Mutual Insurance Union, 12004 Castellon, Spain
- Department of Medicine, Jaume I University, 12006 Castellon, Spain
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Brown RB. Dysregulated phosphate metabolism in autism spectrum disorder: associations and insights for future research. Expert Rev Mol Med 2023; 25:e20. [PMID: 37309057 PMCID: PMC10407224 DOI: 10.1017/erm.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/27/2023] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
Studies of autism spectrum disorder (ASD) related to exposure to toxic levels of dietary phosphate are lacking. Phosphate toxicity from dysregulated phosphate metabolism can negatively impact almost every major organ system of the body, including the central nervous system. The present paper used a grounded theory-literature review method to synthesise associations of dysregulated phosphate metabolism with the aetiology of ASD. Cell signalling in autism has been linked to an altered balance between phosphoinositide kinases, which phosphorylate proteins, and the counteracting effect of phosphatases in neuronal membranes. Glial cell overgrowth in the developing ASD brain can lead to disturbances in neuro-circuitry, neuroinflammation and immune responses which are potentially related to excessive inorganic phosphate. The rise in ASD prevalence has been suggested to originate in changes to the gut microbiome from increasing consumption of additives in processed food, including phosphate additives. Ketogenic diets and dietary patterns that eliminate casein also reduce phosphate intake, which may account for many of the suggested benefits of these diets in children with ASD. Dysregulated phosphate metabolism is causatively linked to comorbid conditions associated with ASD such as cancer, tuberous sclerosis, mitochondrial dysfunction, diabetes, epilepsy, obesity, chronic kidney disease, tauopathy, cardiovascular disease and bone mineral disorders. Associations and proposals presented in this paper offer novel insights and directions for future research linking the aetiology of ASD with dysregulated phosphate metabolism and phosphate toxicity from excessive dietary phosphorus intake.
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Affiliation(s)
- Ronald B. Brown
- University of Waterloo, School of Public Health Sciences, Waterloo, ON N2L 3G1, Canada
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Zhu ZY, Cui M, Zhao J, Wang HY. The efficacy of tolvaptan for heart failure in chronic kidney disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32366. [PMID: 36596041 PMCID: PMC9803466 DOI: 10.1097/md.0000000000032366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Tolvaptan is reported to be effective in treating heart failure. However, the safety and efficacy of its use in patients with CKD is uncertain. In this study, we conducted a protocol for systematic review and meta-analysis to investigate the efficacy and safety of tolvaptan on patients with heart failure and CKD. METHODS This study protocol has been registered in the PROSPERO and the registration number is CRD42022368148. The consent of this protocol report is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement guidelines. We will include randomized controlled trials related to tolvaptan in patients with heart failure and CKD. Two research members will electronically and independently search 4 English databases (EMBASE, PubMed, National Guideline Clearinghouse, and Cochrane Central Register of Controlled Trials) and 4 Chinese databases (Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Wanfang Database, and VIP Database) from their inception to November 2022. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. All statistical analyses will be conducted using the software program Review Manager version 5.3. RESULTS The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION This review can provide convincing evidence to help clinicians make decisions when dealing with heart failure and CKD.
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Affiliation(s)
- Zhi-Yong Zhu
- Department of Nephrology, Zibo Central Hospital, Shandong, China
| | - Meng Cui
- Department of Nephrology, Zibo Central Hospital, Shandong, China
| | - Jie Zhao
- Department of Nephrology, Zibo Central Hospital, Shandong, China
| | - Hong-Yun Wang
- Department of Nephrology, Zibo Central Hospital, Shandong, China
- *Correspondence: Hong-yun Wang, Department of Nephrology, Zibo Central Hospital, 255000 Shandong, China (e-mail: )
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Matusik PT, Heleniak Z, Undas A, Undas A. Anticoagulant Treatment in Patients with Atrial Fibrillation and Chronic Kidney Disease: Practical Issues. Anatol J Cardiol 2022; 26:857-863. [PMID: 36444964 PMCID: PMC9797703 DOI: 10.5152/anatoljcardiol.2022.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Up to 20% of patients with chronic kidney disease have atrial fibrillation, and 40%-50% of atrial fibrillation patients suffer from chronic kidney disease. The 2 diseases share several risk factors and frequently coincide with each other. Both entities are associ ated with a prothrombotic state, which contributes to increased thromboembolic risk. Atrial fibrillation patients with chronic kidney disease have elevated risk of stroke, major bleeding, and mortality. Clinical risk scores, including CHA2DS2-VASc score, HAS-BLED score, or ORBIT score have a limited value in adverse clinical outcome risk stratification in patients with severe chronic kidney disease. However, the inclusion of renal function in the R(2)-CHA2DS2-VASc score does not improve significantly thromboembolic risk predic tion in atrial fibrillation. There is growing evidence suggesting that biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin, cystatin C, or growth differentiation factor-15, might be helpful in the assessment of thromboembolic, bleeding, and/or mortality risk in atrial fibrillation patients with chronic kidney disease. The first-choice anticoagulant therapy is based on direct oral anticoagulants in this subgroup. The highest risk of adverse events is observed in end-stage renal disease, and in Europe, in contrast to the USA, solely warfarin is recommended in such atrial fibrillation patients. Treatment of atrial fibrillation patients with chronic kidney disease should be closely moni tored with the selection of right anticoagulant agents at the appropriate dose. The current review paper summarizes available evidence and the challenges of the management of atrial fibrillation patients with chronic kidney disease with practical implications.
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Affiliation(s)
- Paweł T. Matusik
- The John Paul II Hospital, Kraków, Poland,Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Heleniak
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anetta Undas
- The John Paul II Hospital, Kraków, Poland,Department of Thromboembolic Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland,Corresponding author:Anetta Undas ✉
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Christopher O, Huang Y, Xiong Z, Zhuang X, Liao X. Serum cystatin C, cystatin C level change and risk of atrial fibrillation. Eur J Intern Med 2022; 103:126-127. [PMID: 35868914 DOI: 10.1016/j.ejim.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Odong Christopher
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, China
| | - Yiquan Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, China
| | - Zhenyu Xiong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, China.
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, China.
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11
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Sertcakacilar G, Yildiz GO. Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis. Clin Pract 2022; 12:533-544. [PMID: 35892443 PMCID: PMC9326761 DOI: 10.3390/clinpract12040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 01/28/2023] Open
Abstract
New-onset atrial fibrillation (NOAF) is one of the leading causes of morbidity and mortality, especially in older patients in the intensive care unit (ICU). Although many comorbidities are associated with NOAF, the effect of anemia on the onset of atrial fibrillation is still unknown. This study aimed to test the hypothesis that anemia is associated with an increased risk of developing NOAF in critically ill patients in intensive care. We performed a retrospective analysis of critically ill patients who underwent routine hemoglobin and electrocardiography monitoring in the ICU. Receiver operating characteristics analysis determined the hemoglobin (Hb) value that triggered NOAF formation. Bivariate correlation was used to determine the relationship between anemia and NOAF. The incidence of NOAF was 9.9% in the total population, and 12.8% in the patient group with anemia. Analysis of 1931 patients revealed a negative association between anemia and the development of NOAF in the ICU. The stimulatory Hb cut-off value for the formation of NOAF was determined as 9.64 g/dL. Anemia is associated with the development of NOAF in critically ill patients in intensive care.
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Affiliation(s)
- Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey;
- Correspondence:
| | - Gunes Ozlem Yildiz
- Department of Anesthesiology and Reanimation, University of Health Science, Bakırköy Dr. Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey;
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