P0213CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION: RISK OF COMPLICATIONS
Authors: Abdullaev Sherzod , Igamberdieva Rano 
Published: June 2020

Abstract

Background and Aims
The assessment of the thromboembolic risk (TE) and transient ischemic attacks (TIA) in patients with chronic kidney disease (CKD) in combination with atrial fibrillation (AF) and the effect of complex treatment, including rivoraxaban.

Method
The study included 28 patients, 16 men and 12 women, average age - 57.8 ± 6.9 years. Patients with 3rd stage CKD (GFR 30-50 ml/min) associated with various forms of non-valve AF were examined. All patients were at high risk according to the classification of stroke risk stratification. The risk of thromboembolic complications was assessed using the CHA2DS2-VASc scale. Depending on the form of AF, patients with CKD were divided into 2 groups: with paroxysmal AF and CKD (n = 9) and persistent AF and CKD (n = 19). The average age in the 2 groups was 52.7 ± 6.4 and 58.4 ± 7.4 years, respectively. A history of 11 patients (39.3%) had ischemic stroke and TIA. All patients underwent echocardiography and transesophageal echocardiography (TE EchoCG). The peak blood flow velocity was a quantitative reflection of the hemodynamic state of left atrium (LA). Hemoglobin, creatinine, eGFR (CKD-EPI) and coagulogram were also monitored.

Results
According to the results of TE echocardiography, the size of the LA in patients with stage 3 CKD and paroxysmal AF is less than in the group of persistent AF (43.7±2.8 mm and 48.6±5.8 mm, respectively, p&lt;0.05). The average value of the peak blood flow velocity was reduced in all patients - 34.88±10.59 cm/sec, in the presence of thrombosis this parameter significantly decreased - 24.3±2.49 cm/sec (p&lt;0.001). Atrial thrombi were detected in 10 patients (35.7%). Spontaneous echocardiographic contrast (SEC) was found in 7 people (25%). We found that in patients with a thrombus in the auricle of the LA ejection fraction (EF) was significantly lower than in patients without thrombi. The average score on the CHA2DS2-VASС scale was 5. A higher incidence of a thrombus in the auricle of the LA was revealed in patients with persistent AF than paroxysmal AF (7 and 3, respectively). Only 15 patients (53.6%) received oral anticoagulants (OAC) on an outpatient basis, and 2 (7.1%) took aspirin. In the hospital, everyone was prescribed rivoraxaban in a dose of 15 mg once a day. After 4 weeks of treatment with rivoraxaban, from 7 patients with a revealed SEC during repeated TE echocardiography, the disappearance of SEC was observed in 4 patients (57%). In 6 patients (60%) was revealed thrombus lysis in the LA. In 16 (57.1%) patients was noted an increase in GFR above 50 ml/min. Coagulogram values in all patients throughout the observation were within normal limits.

Conclusion
TE echocardiography allows to distinguish among patients with stage 3 CKD and AF group with a high risk of stroke and TIA. The use of rivoraxaban for 4 weeks allows lysis of blood clots in the auricle of the LA in 60% of patients, and the disappearance of the SEC effect in 57% of cases. This allows us to recommend rivoraxaban for the treatment of patients with AF, especially with a high risk of thromboembolic complications.