ArticleHeart rhythm O22026
Impact of end-stage renal disease on stroke risk in patients with atrial fibrillation.
Article in Heart rhythm O2, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Background: Patients with end-stage renal disease (ESRD) and atrial fibrillation (AF) face paradoxical risks of both thrombosis and bleeding, creating uncertainty regarding stroke risk and optimal anticoagulation (AC) strategies. Objectives: This study evaluated the impact of ESRD on stroke risk and mortality in patients with AF using a large national cohort. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database for 2018-2019. Adult patients (≥18 years) with AF were stratified by ESRD status. Propensity score matching (1:1) was performed using baseline demographic and comorbidity variables. Primary outcomes included ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), and all-cause mortality. Results: Of 1,749,172 patients with AF, 89,741 (5.1%) had ESRD. After propensity matching (68,653 pairs), patients with ESRD showed significantly lower rates of ischemic stroke (1.8% vs 3.1%; Conclusion: Patients with AF with ESRD had lower cerebrovascular event rates despite lower AC use, suggesting that uremic platelet dysfunction and intradialytic heparin exposure may confer protective AC effects. These findings challenge traditional stroke risk assumptions and highlight the need for ESRD-specific risk-stratification tools and individualized shared decision making.
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