Predictors of New-Onset Atrial Fibrillation in Patients with ESKD: A Multicenter, Retrospective, Observational Cohort Study

Background: According to the CDC, A.Fib is the most prevalent heart arrhythmia, cited in 183,321 US deaths in 2019, with 26,535 directly attributed. ESRD is a leading cause of US mortality, impacting 37 million adults. Previous studies link CKD with increased A.fib risk, possibly due to shared risk factors. Our study examines predictive factors for new onset A.fib in ESRD patients at Northwell Health System. Methods: 6,814 cases of ESRD patients were identified from February 2018 to December 2020. Patients with a prior history of A.Fib were excluded. Patients with missing or extreme BMI data and missing tobacco use data were excluded. Sample size was 5,326. 1,564 diagnosed with ESRD experienced new-onset A.Fib (cases) while 3,762 had no history of A.Fib (controls). Predictors studied were CAD, BMI, Sex, Race, Ethnicity, HTN, Diabetes (DM), and Smoking Status. Results: Out of the 5,326 ESRD patients, 1,564 (29.4%) were cases, and 3,762 (70.6%) were controls. Increasing age (OR 1.038/yr, p<0.0001), obesity (OR 1.225, p=0.0135), and CAD (OR 1.682, 95%, p<0.0001) were linked to higher odds of A.Fib. African American and other racial patients had decreased odds compared to Whites (OR 0.581 and OR 0.772, respectively). HTN, sex, DM, and smoking did not significantly associate with A.Fib risk. Conclusion: Age, obesity, and CAD were risk factors for new onset Afib in ESRD, while African American and other racial patients had lower odds compared to Whites. HTN, sex, DM, and smoking showed no significant associations. Further research should delve into underlying mechanisms, explore interventions for A.Fib risk in vulnerable populations, and assess demographic factors' impact on outcomes.