Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS),
we determined incidence, prevalence, and outcomes among hemodialysis patients with
atrial fibrillation. Cox proportional hazards models, to identify associations with
newly diagnosed atrial fibrillation and clinical outcomes, were stratified by country
and study phase and adjusted for descriptive characteristics and comorbidities. Of
17,513 randomly sampled patients, 2188 had preexisting atrial fibrillation, with wide
variation in prevalence across countries. Advanced age, non-black race, higher facility
mean dialysate calcium, prosthetic heart valves, and valvular heart disease were associated
with higher risk of new atrial fibrillation. Atrial fibrillation at study enrollment
was positively associated with all-cause mortality and stroke. The CHADS2 score identified
approximately equal-size groups of hemodialysis patients with atrial fibrillation
with low (less than 2) and higher risk (more than 4) for subsequent strokes on a per
100 patient-year basis. Among patients with atrial fibrillation, warfarin use was
associated with a significantly higher stroke risk, particularly in those over 75
years of age. Our study shows that atrial fibrillation is common and associated with
elevated risk of adverse clinical outcomes, and this risk is even higher among elderly
patients prescribed warfarin. The effectiveness and safety of warfarin in hemodialysis
patients require additional investigation.