title: Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients.
abstract: 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.
authors.affiliation: Dipartimento di Medicina Clinica Prevenzione e Biotecnologie Sanitarie, Università degli Studi Milano, Bicocca, Italy. simonetta.genovesi@unimib.it
authors.forename: Simonetta
authors.initials: S
authors.lastname: Genovesi
authors.forename: Daniela
authors.initials: D
authors.lastname: Pogliani
authors.forename: Andrea
authors.initials: A
authors.lastname: Faini
authors.forename: Maria G
authors.initials: MG
authors.lastname: Valsecchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Riva
authors.forename: Francesca
authors.initials: F
authors.lastname: Stefani
authors.forename: Irene
authors.initials: I
authors.lastname: Acquistapace
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bonforte
authors.forename: Amedeo
authors.initials: A
authors.lastname: DeVecchi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: DeCristofaro
authors.forename: Gherardo
authors.initials: G
authors.lastname: Buccianti
authors.forename: Antonio
authors.initials: A
authors.lastname: Vincenti
mesh_terms: 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