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

Background. The incidence of intracardiac thrombosis in haemodialysispatients has not been studied. Here we determined the incidencein end-stage renal disease patients on maintenance haemodialysis. Methods. Transoesophageal echocardiography was performed in215 patients (125 males, 90 females; mean age 60 ± 9years). Any potential candidate with current or past chronicor intermittent atrial fibrillation or with cardiovascular diseaseswas excluded from the study. Results. Thrombi were found in the left atrial appendages in71 out of 215 subjects (33%). Based on multiple logistic regressionanalyses, the probability of finding a thrombus was found tobe increased in patients on chronic antiplatelet therapy (oddsratio 4.268) and in those with diabetes mellitus and a low haematocrit(0.3; odds ratio 7.173). Other clinical parameters, includinggender, age, duration of haemodialysis, blood pressure, leftventricular dimension, smoking habit or type of anticoagulationduring dialysis, were not associated with the incidence of leftatrial appendage thrombosis. Conclusions. Maintenance haemodialysis patients have a highincidence of left atrial appendage thrombosis. Either chronicuse of antiplatelet drugs or the background conditions requiringantiplatelet therapy, and the concomitant presence of diabetesmellitus and a low haematocrit may be involved in left atrialappendage thrombosis.