The Predictors of New-Onset Atrial Fibrillation in End-Stage Renal Disease Patients: A Multi-Center Retrospective Observational Study.

Background/Objectives: Atrial fibrillation (AF) is a significant and prevalent cardiovascular complication in end-stage renal disease (ESRD) patients, yet its specific predictors within this population are not well understood. This study aimed to identify the predictors of new-onset AF in ESRD patients undergoing dialysis. Methods: We conducted a retrospective multicenter cohort study within the Northwell Health System, analyzing data from 5326 ESRD patients on dialysis between 2017 and 2019. The mean age was 64.2 ± 13.1 years, with 48.3% females. Multivariable-adjusted logistic regression was used to identify predictors of new-onset AF, the primary outcome. Adjusted odds ratios (ORs) were calculated for potential risk factors. Results: Of the 5326 patients, 1564 (29.4%) developed new-onset AF. Significant predictors included increasing age (OR 1.038 per year, 95% CI 1.032-1.044, p < 0.0001), obesity (BMI > 30 vs. BMI 20-25: OR 1.208, 95% CI 1.026-1.422, p = 0.023), and coronary artery disease (OR 1.678, 95% CI 1.466-1.920, p < 0.0001). African American patients had lower odds of developing AF compared to White patients (OR 0.578, 95% CI 0.494-0.676, p < 0.0001). Hypertension, sex, diabetes, and tobacco use were not significantly associated with AF risk. Conclusions: Age, obesity, and coronary artery disease are significant predictors of new-onset AF in ESRD patients on dialysis. Notable racial disparities exist, with African American patients having a lower risk. These findings may inform targeted prevention strategies and guide future research into the mechanisms underlying AF in ESRD patients.