Atrial fibrillation, end-stage renal disease and hemorrhagic pleural-pericarditis

Raluca-Mihaela Leonte, Laurențiu Vladimir Lucaci, Cristiana Elena Vlad, Andreea Florea, Laura Florea


Pericarditis is the most common pericardial disease found in clinical practice, with an incidence of acute pericarditis reported in 27.7 cases per 100,000 subjects per year. Hemodialysis in end stage renal disease (ESRD) is associated with frequent cardiovascular modifications, mostly because of the highly fluctuating levels of potassium, magnesium, ionized calcium, sodium and volume status. The risk of arrhythmias is increased and chronic atrial fibrillation (AF) can be found among approximately 14% of patients. The renal disease combined with arrhythmias increases the risk of systemic thromboembolism but also of bleeding events. Here we present the case of a male patient, with ESRD, recently diagnosed with intradialytic paroxysmal AF for which oral anticoagulation therapy is initiated, but it’s early complicated with hemorrhagic pleural-pericarditis.


hemorrhagic pleural-pericarditis, atrial fibrillation, ESRD, hemodialysis

Full Text:



Hoit BD. Anatomy and Physiology of the Pericardium. Cardiol Clin 2017; 35(4):481-490.

Maisch B. Management of pericarditis and pericardial effusion, constrictive and effusive-constrictive pericarditis. Herz 2018; 43(7):663-678.

LeWinter MM. Clinical practice. Acute pericarditis. N Engl J Med 2014; 371(25):2410-2416.

Imazio M, Gaita F. Diagnosis and treatment of pericarditis. Heart 2015; 101(14):1159-1168.

Genovesi S, Pogliani D, Faini A, Valsecchi M, Riva A. Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. Am J Kidney Dis 2005; 46(5):897-902

Voroneanu L, Covic A, Arrhythmias in hemodialysis patients. J Nephrol 2009; 22 (6):716- 725.

Vázquez E, Sánchez-Perales C, Borrego F, et al. Influence of atrial fibrillation on the morbido-mortality of patients on hemodialysis. Am Heart J 2000; 140:886-890.

Goto S, Angchaisuksiri P, Bassand J, et al. Management and 1‐year outcomes of patients with newly diagnosed atrial fibrillation and chronic kidney disease: results from the prospective GARFIELD‐AF registry. J Am Heart Assoc 2019; 8(3): e010510. doi: 10.1161/JAHA.118.010510.

Winkelmayer WC, Patrick AR, Liu J, Brookhart A, Setoguchi S. The increasing prevalence of atrial fibrillation among hemodialysis patients. J Am Soc Nephrol 2011; 22(2):349-357.

Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ. Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol 2007; 3(3):138–153.

Jalal D, Chonchol M, Targher G. Disorders of hemostasis associated with chronic kidney disease. Semin Thromb Hemost 2010; 36(1):34-40.

Bonde AN, Lip GYH, Kamper AL, et al. Net clinical benefit of antithrombotic therapy in patients with atrial fibrillation and chronic kidney disease: a nationwide observational cohort study. J Am Coll Cardiol 2014; 64(23):2471–2482.

January CT, Wann LS, Alpert JS, et al. AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64(21):e1–76.

Harel Z, Chertow GM, Shah PS, et al. Warfarin and the risk of stroke and bleeding in patients with atrial fibrillation receiving dialysis: a systematic review and meta-analysis. Can J Cardiol 2017; 33:737–746.

Adams MJ, Irish AB, Watts GF, Oostryck R, Dogra GK. Hypercoagulability in chronic kidney dis- ease is associated with coagulation activation but not endothelial function. Thromb Res 2008; 123:374–380.

Ball T, Wheelan K, McCullough P. Chronic anticoagulation in chronic kidney disease. J Am Coll Cardiol 2014; 64(23): 2483-2485.

Hussain S, Siddiqui AN, Baxi H, Habib A, Hussain MS, Najmi AK. Warfarin use increases bleeding risk in hemodialysis patients with atrial fibrillation: a meta-analysis of cohort studies. J Gastroenterol Hepatol 2019; 34(6):975-984.

Małyszko J, Małyszko JS, Myliwiec M. Endothelial cell injury markers in chronic renal failure on conservative treatment and continuous ambulatory peritoneal dialysis. Kidney Blood Press Res 2004; 27(2):71–77.

Huang Y, Noble NA. PAI-1 as a target in kidney disease. Curr Drug Targets 2007; 8(9):1007–1015.

Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC), The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36(42):2921–2964.

Ntsekhe M, Mayosi BM. Tuberculous pericarditis with and without HIV. Heart Fail Rev 2013; 18(3):367-373.

Restrepo CS, Vargas D, Ocazionez D, Martínez-Jiménez S, Betancourt Cuellar SL, Gutierrez FR, Primary pericardial tumors. Radiographics 2013; 33(6):1613-1630.


Copyright (c) 2020 Raluca-Mihaela Leonte, Laurențiu Vladimir Lucaci, Cristiana Elena Vlad, Andreea Florea, Laura Florea

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


ISSN: 2360-6975