Risk factors of new atrial fibrillation in patients undergoing maintenance hemodialysis with autoarteriovenous fistula

ZHANG Wei; XIN Fang-ran; JIA Xiao-dan; ZHANG Yu-ji

doi:10.16048/j.issn.2095-5561.2024.01.04

Abstract：Objective To investigate the risk factors of new atrial fibrillation(AF) in patients undergoing maintenance hemodialysis with autoarteriovenous fistula. Methods A total of 134 patients undergoing maintenance hemodialysis with autoarteriovenous fistula from January 2017 to November 2022 were selected as the study objects. Among them, 67 patients with new AF were included in the AF group,and the AF group was divided into paroxysmal atrial fibrillation(PAF) subgroup(n=26) and non-paroxysmal atrial fibrillation(NPAF) subgroup(n=41) according to AF type. A total of 67 patients who were hospitalized during the same period and did not develop AF were included in the non-AF group. The clinical indicators of patients in AF group and non-AF group were compared, univariate and multivariate Logistic regression analysis was used to explore the possible risk factors for AF, and the clinical indicators of patients in paroxysmal AF subgroup and non-paroxysmal AF subgroup were compared. Univariate and multivariate Logistic regression analysis were used to explore the risk factors for the persistent development of new AF. The predictive value of risk factors for new AF in maintenance hemodialysis patients was evaluated using receiver operating characteristic(ROC) curves. Results Multivariate Logistic regression analysis showed that left atrial diameter enlargement and N-terminal pro-B-type natriuretic peptide>35000 pg/ml were independent risk factors for new AF in maintenance hemodialysis patients. Multivariate Logistic regression analysis showed that increased interventricular septal thickness was a risk factor for the continuous development of new AF in maintenance hemodialysis patients. ROC curve results showed that the area under the curve of the left atrial diameter was 0.772, 95％ confidence interval was 0.693-0.851, the optimal critical value was 40.5 mm, the sensitivity was 53.7％, and the specificity was 91.0％. Conclusion Left atrial diameter enlargement and N-terminal B-type natriuretic peptide>35000 pg/ml were independent risk factors for new AF in maintenance hemodialysis patients.Increased interventricular septal thickness is a risk factor for the persistent development of new AF in maintenance hemodialysis patients. The left atrial diameter has a good predictive value for AF occurrence, and when the left atrial diameter is not less than 40.5 mm, the prediction effect is higher.