Sleep apnea is associated with new-onset atrial fibrillation in patients undergoing peritoneal dialysis

There are few data on the incidence and related risk factors and adverse outcomes of new-onset atrial fibrillation (NOAF) in patients receiving maintenance peritoneal dialysis (PD). In this observational retrospective, multicenter real-world study we included all patients that received PD for over 30 days in 2009–2019 in two research hospitals. The primary and secondary outcomes of the study were the incidence of NOAF and electrical direct current cardioversion (DCCV) during PD. Incident strokes and mortality were also recorded. Altogether 401 patients with a median PD treatment duration of 1.6 years (IQR 0.9–2.8 years or 850 patient-years) comprised the total study cohort and 64 (16%) had a prior diagnosis of AF. NOAF was observed in 46 (13.6%) of the 337 patients without prior history of AF corresponding with the incidence rate of 6.3 per 100 patient-years. In a multivariable Cox model, cirrhosis (HR 5.536, CI95% 1.266–24.207, p = 0.023) coronary artery disease (CAD) (HR 2.268, CI95% 1.178–4.366, p = 0.014) and sleep apnea (HR 2.472, CI95% 1.010–6.048, p = 0.047) were independently associated with incident NOAF during PD but only the association with sleep apnea remained significant (HR 3.182, CI95% 1.399–7.238, p = 0.006) in a further multivariable Cox model adjusted with age, sex, CAD and PD vintage. Moreover, the observed percentage of NOAF during PD was as high as 50% in patients over 60 years old with a prior diagnosis of sleep apnea. Furthermore, 18 DCCVs in 6 patients and 27 (6.7%) strokes were observed and 100 (24.9%) patients died during PD care out of the total study cohort. The occurrence of NOAF was not associated with the incidence of stroke or mortality during PD. In this real-world multicenter study, a substantially high incidence of NOAF and an expectedly low occurrence of DCCVs in patients receiving maintenance PD was observed. Furthermore, an independent association between sleep apnea and the risk of NOAF in this patient population was observed.