Investigation of the Atrial Fibrillation Risk in Hemodialysis Patients: A Population-Based Cohort Study

Background and Purpose: Previous studies have reported that hemodialysis (HD) patients generally are at higher risk of cardiovascular diseases; however, the association between HD patients and atrial fibrillation risk is still inconclusive. Therefore, we explored the incidence and risk of atrial fibrillation among hemodialysis patients in Taiwan. Methods: A total of 15,622 HD patients were selected from Taiwan’s National Health Insurance Research Database. A total of 54,243 individuals without chronic kidney disease were randomly selected as controls. A hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the risk of atrial fibrillation using a Cox proportional hazards model. Results: We observed that 6188 controls and 5902 HD patients had new-onset atrial fibrillation. The incidence rate ratio for atrial fibrillation was 2.29 (95% CI 2.13-2.46) and the adjusted HR for atrial fibrillation risk was 1.95 (95% CI 1.76-2.17) in the HD patients. In particular, those HD patients with an older age, diabetes mellitus, hypertension, hyperlipidemia, or ischemic heart disease had a significantly higher risk of atrial fibrillation. Conclusions: Our results revealed that older hemodialysis patients with certain comorbidities had an increased risk of atrial fibrillation. We should pay particular attention to the clinical care of hemodialysis patients with these specific risk factors.