Outcome of atrial fibrillation among patients with end-stage renal disease.

BACKGROUND: End-stage renal disease (ESRD) patients are more at risk for atrial fibrillation (AF) than the general population. However, the prognosis in ESRD patients with paroxysmal AF (PaAF), permanent AF (PAF) and paroxysmal AF transformed to permanent AF (TAF) is unknown.

METHODS: In this retrospective longitudinal study, all ESRD patients with PaAF, PAF and TAF between January 2001 and December 2007 were reviewed. The development of thromboembolic events (TEE) was analyzed using Kaplan-Meier analysis and Cox regression.

RESULTS: A total of 81 patients with PaAF, 49 patients with PAF and 89 patients with TAF were reviewed. Seventy-two (32.9%) patients developed TEE, and 63 (28.8%) patients died in 36.9 +/- 21.9 months. Patient survival was not significantly different between patients with different types of AF (P = 0.728). Patients with PaAF had a significantly lower TEE-free survival compared to patients with PAF (P = 0.036). In multivariate Cox regression, patients with paroxysmal AF were more at risk for TEE (P = 0.045) with a hazard ratio of 1.61 (95% confidence interval: 1.01-2.58). PaAF and congestive heart failure, hypertension, age older than 75 years, diabetes, and previous stroke or transient ischemic stroke (CHADS(2)) score were independently associated with an increase in TEE risk (P = 0.028 and P = 0.03).

CONCLUSION: Patient survival is not different in patients with paroxysmal and permanent atrial fibrillation. However, patients with paroxysmal AF are more at risk for the development of TEE than those with permanent AF.