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Nephrol Dial Transplant (2003) 18: 2339-2347
© 2003 European Renal Association-European Dialysis and Transplant Association

Original Article

The high incidence of left atrial appendage thrombosis in patients on maintenance haemodialysis

Masato Nishimura1, Tetsuya Hashimoto2, Hiroyuki Kobayashi2, Toyofumi Fukuda2, Koji Okino3, Noriyuki Yamamoto2, Noriyuki Iwamoto4, Naoto Nakamura5, Toshikazu Yoshikawa5 and Toshihiko Ono2

1Cardiovascular Division, 2Division of Urology and 3Division of Surgery, Toujinkai Hospital, 4Department of Urology, Kyoto First Red Cross Hospital and 5First Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

Correspondence and offprint requests to: Masato Nishimura, MD, Cardiovascular Division, Toujinkai Hospital, 16, Negoro, Momoyama-cho, Fushimi-ku, Kyoto 612-8024, Japan. Email: tojinkai.hosp{at}dream.com

Background. The incidence of intracardiac thrombosis in haemodialysis patients has not been studied. Here we determined the incidence in end-stage renal disease patients on maintenance haemodialysis.

Methods. Transoesophageal echocardiography was performed in 215 patients (125 males, 90 females; mean age 60 ± 9 years). Any potential candidate with current or past chronic or intermittent atrial fibrillation or with cardiovascular diseases was excluded from the study.

Results. Thrombi were found in the left atrial appendages in 71 out of 215 subjects (33%). Based on multiple logistic regression analyses, the probability of finding a thrombus was found to be increased in patients on chronic antiplatelet therapy (odds ratio 4.268) and in those with diabetes mellitus and a low haematocrit (<=0.3; odds ratio 7.173). Other clinical parameters, including gender, age, duration of haemodialysis, blood pressure, left ventricular dimension, smoking habit or type of anticoagulation during dialysis, were not associated with the incidence of left atrial appendage thrombosis.

Conclusions. Maintenance haemodialysis patients have a high incidence of left atrial appendage thrombosis. Either chronic use of antiplatelet drugs or the background conditions requiring antiplatelet therapy, and the concomitant presence of diabetes mellitus and a low haematocrit may be involved in left atrial appendage thrombosis.

Keywords: antiplatelet therapy; diabetes mellitus; haematocrit; haemodialysis; left atrial appendage; thrombosis


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