Over the past few decades, a series of innovative medicines have been developed in order to optimize anticoagulation therapy for atrial fibrillation (AF). As a result, a number of nonvitamin K antagonist oral anticoagulants (NOAC) that directly target the enzymatic activity of factor II and factor Xa have been successfully licensed providing a more predictable effect and better safety profile compared to conventional anticoagulants (heparins and vitamin K antagonists (VKAs)). However, comparative efficacy and safety data is limited in patients with advanced chronic kidney disease (i.e., CKD stage 4/5 and end stage renal disease) because patients with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 were actively excluded from landmark trials, thus representing a major clinical limitation for the currently available agents. However, the renal function of AF patients can be altered over time. On the other hand, patients with CKD have an increased risk of developing AF. This review article will provide an overview of current concepts and recent evidence guiding the clinical use of NOACs in patients with CKD requiring chronic anticoagulation, and the associated risks and benefits of treatment in this specific patient population.
Chronic kidney disease (CKD) is one of the clinical features characterized by progressive and irreversible loss of renal function. The incidence of this pathology is constantly increasing globally, due to the growing number of patients diagnosed with diabetes and hypertension, both diseases generating tubular fibrosis and kidney dysfunction. Through experimental models for the production of tubulo-interstitial fibrosis (TIF), we try to understand deeply and comprehensively the main pathogenic mechanisms that govern the onset, progression and worsening of CKD. Understanding the mechanisms underlying the production of this pathology, one can try therapeutic methods to produce an evolutionary slowdown in CKD and also translate the main benefits in clinical practice, based on these experimental models of basic research.
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