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Dtsch Med Wochenschr 2024; 149(12): 724-727
DOI: 10.1055/a-2149-4290
Klinischer Fortschritt
Nephrologie

Vorhofflimmern – Was ist bei chronischer Nierenerkrankung und Hämodialyse zu beachten?

Atrial fibrillation – what should be taken into account with chronic kidney disease and hemodialysis?
Georg Schlieper
1   Zentrum für Nieren-, Hochdruck- und Stoffwechselerkrankungen, Hannover
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Was ist neu?

Scores zur Risikoeinschätzung Die chronische Nierenerkrankung (CKD) ist eine häufige Komorbidität bei Vorhofflimmern, wobei der CHA2DS2-VASc-Score bei höhergradiger CKD nicht validiert ist und bei Dialysepatienten nur einen geringen prädiktiven Wert aufweist.

Risikoreduktion Nach den aktuellen Empfehlungen der European Society of Cardiology (ESC) sind Nicht-Vitamin-K-antagonistische Orale Antikoagulanzien (NOAK) einer Vitamin-K-Hemmung vorzuziehen. Aufgrund der teilweisen renalen Elimination von NOAK ist die Dosis bei CKD anzupassen. Mehrere Studien deuten inzwischen auf ein akzeptables Sicherheitsprofil von NOAKs bei CKD hin, wobei größere randomisierte Studien nach wie vor fehlen. Die Ergebnisse von prospektiven Studien mit einem Placebo-Behandlungsarm, d.h. ohne Antikoagulationstherapie, sind noch ausstehend.

Vorhofohrverschluss bei Kontraindikationen Sollten Kontraindikationen für eine antithrombotische Therapie vorliegen, kann ein Vorhofohrverschluss diskutiert werden. Die Wirksamkeit und Sicherheit des Vorhofohrverschlusses muss jedoch noch besser evaluiert werden.

Abstract

CKD is a common comorbidity in patients with atrial fibrillation. The CHA2DS2-VASc score is not validated in patients with severe CKD and has a low predictive value in dialysis patients. As NOACs are partly eliminated by the kidneys the dosage has to be adapted in CKD. Recent studies indicate an acceptable safety profile for NOACs in CKD. However, larger randomized studies are still lacking. The results from prospective studies with placebo i.e., no anticoagulation therapy, are pending.

Schlüsselwörter

Vorhofflimmern - chronischer Nierenerkrankung - Hämodialyse - Risiko-Scores - NOAK - Vitamin-K-Antagonist

Keywords

atrial fibrillation - chronic kidney disease - hemodialysis - risk scores - NOAC - Vitamin K antagonist


Publication History

Article published online:
23 May 2024

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