Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients.
BACKGROUND
Hemodialysis (HD) is associated with cardiovascular structural modifications; moreover, during HD, rapid electrolytic changes occur. Both factors may favor the onset of atrial fibrillation.


METHODS
To define the prevalence of atrial fibrillation and identify associated factors, 488 patients on long-term HD therapy (age, 66.6 +/- 13.4 years; men, 58.0%; duration of HD, 76.5 +/- 84.3 months) were studied.


RESULTS
Atrial fibrillation was reported in 27.0% of patients; paroxysmal in 3.5%, persistent in 9.6%, and permanent in 13.9%. Clinical and echocardiographic variables were considered: patients with atrial fibrillation were older (71.8 +/- 9.3 versus 64.7 +/- 14.2 years; P < 0.01), and its prevalence increased with age. Patients with arrhythmia had a longer duration of dialysis therapy (93.2 +/- 100.5 versus 70.2 +/- 76.7 months; P = 0.02). Atrial fibrillation was associated significantly with ischemic heart disease (P < 0.01), dilated cardiomyopathy (P < 0.01), acute pulmonary edema (P < 0.05), valvular disease (P < 0.05), cerebrovascular accidents (P < 0.05), and predialytic hyperkalemia (P < 0.05). Patients with atrial fibrillation more frequently showed left atrial dilatation (59.8% versus 34.5%; P < 0.0001), and in these subjects, left ventricular ejection fraction was significantly lower (53.9% versus 57.4%; P = 0.029). No association was found between arrhythmia and hypertension or diabetes. Multivariate analysis confirmed that patient age (P < 0.001), duration of HD therapy (P = 0.001), and left atrial dilatation (P < 0.001) were associated with atrial fibrillation.


CONCLUSIONS
Atrial fibrillation is much more frequent in HD patients than in the general population; age, duration of HD history, presence of some heart diseases, and left atrial dilatation are associated with the arrhythmia.
Genovesi
Simonetta
S
Dipartimento di Medicina Clinica Prevenzione e Biotecnologie Sanitarie, Università degli Studi Milano, Bicocca, Italy. simonetta.genovesi@unimib.it
Pogliani
Daniela
D
Faini
Andrea
A
Valsecchi
Maria G
MG
Riva
Alessandra
A
Stefani
Francesca
F
Acquistapace
Irene
I
Stella
Andrea
A
Bonforte
Giuseppe
G
DeVecchi
Amedeo
A
DeCristofaro
Vincenzo
V
Buccianti
Gherardo
G
Vincenti
Antonio
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006947:Hyperkalemia / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D011654:Pulmonary Edema / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography