The prevalence and predictors of atrial fibrillation in hemodialysis patients

OBJECTIVES
The aim of this study was to determine the prevalence of atrial fibrillation in long-term hemodialysis patients and to identify clinical and echocardiographic risk factors.

STUDY DESIGN
The study included 183 patients (93 males, 90 females; mean age 52±17 years) who had been on long-term hemodialysis treatment (mean 41.6±39.8 months) and had preserved systolic function. Atrial fibrillation was determined electrocardiographically and the patients were divided into two groups depending on the presence or absence of atrial fibrillation. Conventional and tissue Doppler echocardiographic examinations were performed on interdialytic days. Clinical, laboratory, and echocardiographic parameters were compared.

RESULTS
Twenty-four patients (13.1%) had atrial fibrillation. Patients with atrial fibrillation significantly differed in terms of higher age (64.9±9.8 vs. 49.9±16.6 years; p<0.001), higher frequency of coronary artery disease (37.5% vs. 10.7%; p=0.008), and lower serum albumin level (3.6±0.4 vs. 3.9±0.5 mg/dl; p=0.015). Echocardiographic examination showed significantly increased left and right atrial diameters (p<0.05), higher incidence of mitral and/or aortic calcification (p=0.033), increased systolic pulmonary artery pressure (38.1±6.1 vs. 28.5±5.5 mmHg, p<0.001) and E/E’ ratio (11.8±3.8 vs. 8.8±4.7, p=0.008) in patients with atrial fibrillation. In multivariate logistic regression analysis, age (OR 1.09; 95% CI 1.00-1.17; p=0.036) and right atrial diameter (OR 1.19; 95% CI 1.05-1.35; p=0.008) were independent risk factors for the development of atrial fibrillation.

CONCLUSION
Our findings highlight age and right atrial diameter as independent predictors of atrial fibrillation in hemodialysis patients. In addition, the E/E’ ratio and pulmonary artery pressure may be considered new risk factors of atrial fibrillation in this population.