Objective To explore the prevalence and related factors of atrial fibrillation(AF)in maintenance hemodialysis (MHD)patients. Methods Patients undergoing MHD at Beijing ChaoYang Hospital Affiliated to Capital Medical University from March to August 2022 were enrolled, and were divided into AF group and non-atrial fibrillation(non-AF)group based on whether they had atrial fibrillation. Multivariate logistic regression model and receiver operator characteristic(ROC)curves were used to evaluate the related factors of AF and its predictive value. Results A total of 117 patients were enrolled. Patients in AF group had significantly higher age,hemodialysis vintage,ultrafiltration rate,red blood cell distribution width, high-sensitivity C-reactive protein(hs-CRP),brain natriuretic peptide,and left atrial diameter than those in non-AF group,while serum albumin and left ventricular ejection fraction were significantly lower in AF group(P< 0.05). Multivariate logistic analysis showed that left atrial diameter,ultrafiltration rate, hemodialysis vintage,hs-CRP and advanced age were related factors for AF(P< 0.05). The area under the ROC curve of ultrafiltration rate was 0.695, and the optimal cut-off value was 11.6 ml/(kg·h). Conclusions The proportion of asymptomatic atrial fibrillation in MHD patients is high,and it often occurs during the dialysis process. Left atrial diameter, ultrafiltration rate, hemodialysis vintage, hs-CRP and age are related factors of AF.
Key words
hemodialysis /
atrial fibrillation /
ultrafiltration rate /
brain natriuretic peptide /
related factor
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References
[1] Liao J N, Chao T F, Liu CJ, et al. Incidence and risk factors for new-onset atrial fibrillation among patients with end-stage renal disease undergoing renal replacement therapy[J]. Kidney Int, 2015, 87(6):1209-1215.
[2] 中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会,中国房颤中心联盟心房颤动防治专家工作委员会.心房颤动:目前的认识和治疗建议(2021)[J].中华心律失常学杂志,2022,26(1):15-88.
[3] Zimmerman D, Sood M M, Rigatto C, et al. Systematic review and meta-analysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis[J]. Nephrol Dial Transplant,2012,27(10):3816-3822.
[4] Buiten M S, de Bie M K, Rotmans J I, et al. The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients[J].Heart,2014,100(9):685-690.
[5] 薛佳,姚艳.心房衰老与心房颤动[J].中华内科杂志,2022,61(8):965-968.
[6] Abuhasira R, Mizrakli Y, Shimony A, et al. Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis[J]. Sci Rep,2018,8(1):2976.
[7] Flythe J E, Liu S, Montez-Rath M E, et al. Ultrafiltration rate and incident atrial fibrillation among older individuals initiating hemodialysis[J]. Nephrol Dial Transplant,2021,36(11):2084-2093.
[8] Baek S D, Jeung S, Kang J Y, et al. Dialysis-specific factors and incident atrial fibrillation in hemodialysis patients[J]. Ren Fail,2020,42(1):785-791.
[9] Chang T I, Liu S, Airy M, et al. Blood pressure and incident atrial fibrillation in older patients initiating hemodialysis[J]. Clin J Am Soc Nephrol,2019,14(7):1029-1038.
[10] Issac T T, Dokainish H, Lakkis N M.Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data[J]. J Am Coll Cardiol,2007,50(21):2021-2028.
[11] Chung M K, Martin D O, Sprecher D, et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation[J]. Circulation,2001,104(24):2886-2891.
[12] Börschel C S, Ortega-Alonso A, Havulinna A S, et al. Inflammatory proteomics profiling for prediction of incident atrial fibrillation[J]. Heart,2023,109(13):1000-1006.
[13] Tanaka A, Inaguma D, Shinjo H, et al. Incidence rate of atrial fibrillation after dialysis initiation and its relationship with cardiovascular events[J]. Acta Cardiol,2019,74(6):527-535.
[14] Zhang T, Zhu Z, Yang H, et al. Association between red blood cell distribution width and non-valvular atrial fibrillation in hemodialysis patients: a single-center Chinese population study[J]. Ren Fail,2022,44(1):62-69.
[15] Kumarathurai P, Mouridsen M R, Mattsson N, et al. Atrial ectopy and N-terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study[J]. Europace,2017,19(3):364-370.
[16] Nishikimi T, Futoo Y, Tamano K, et al. Plasma brain natriuretic peptide levels in chronic hemodialysis patients: influence of coronary artery disease[J]. Am J Kidney Dis,2001,37(6):1201-1208.
[17] Niizuma S, Iwanaga Y, Yahata T, et al. Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients[J]. Nephrol Dial Transplant,2009,24(2):597-603.
[18] Zoccali C, Mallamaci F, Benedetto F A, et al. Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients[J]. J Am Soc Nephrol,2001,12(7):1508-1515.
[19] Taskapan M C, Senel S, Ulutas O, et al. Brain natriuretic peptide and P wave duration in dialysis patients[J]. Int Urol Nephrol,2007,39(2):603-608.