New-onset atrial fibrillation in patients with acute kidney injury on continuous renal replacement therapy

• Published in: Journal of critical care Vol. 62; pp. 157 - 163
• Main Authors: Shawwa, Khaled, Kompotiatis, Panagiotis, Bobart, Shane A., Mara, Kristin C., Wiley, Brandon M., Jentzer, Jacob C., Kashani, Kianoush B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021; Elsevier Limited
• Subjects: Acute kidney injury; Cardiac arrhythmia; Comorbidity; Critical care; Electrolytes; Heart failure; Kidneys; Medical prognosis; Mortality; New-onset atrial fibrillation; Patients; Peritoneal dialysis; Renal replacement therapy; Sepsis; Ventilators; United States > US; ESRD; NOAF; OR; Acute kidney injury; Mortality; CI; Critical care; HR; EMR; IQR; MAKE; CRRT; SD; ICU; New-onset atrial fibrillation; Renal replacement therapy; CKD; AKI
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.12.010

The mortality of critically ill patients with acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT) remains high. We assessed the incidence and predictors of new-onset atrial fibrillation (NOAF) in this population and its impact on outcomes.
This is a retrospective cohort study of adult intensive care units (ICU) patients who had AKI and received CRRT from December 2006 through November 2015 in a tertiary academic medical center. Cox proportional hazard model was used to evaluate the impact of NOAF on overall mortality.
Out of 1398 screened patients, NOAF occurred in 193 (14%) cases. NOAF occurring on CRRT was independently associated with an increased hazard of death at follow-up (HR: 1.26; 95% CI: 1.03–1.56), compared to the group who did not have NOAF. In the multivariable analysis using time-dependent covariates, higher potassium (HR 1.24, 95%CI: 1.01–1.54) and bicarbonate (HR 0.95, 95%CI: 0.92–0.98) levels were associated with increased and decreased risk of NOAF on CRRT, respectively.
NOAF in critically ill patients with AKI receiving CRRT is common and carries an unfavorable prognosis. Prospective studies are required to elucidate modifiable risk factors for NOAF occurring on CRRT.
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•Patients with AKI requiring CRRT have dismal prognosis with scarce modifiable factors.•NOAF was common (14%) in patients with AKI on CRRT and had worse prognosis.•Higher potassium and lower bicarbonate levels increased risk for NOAF.•In all ICU, except cardiac surgery, cumulative fluid balance increased risk for NOAF.