Management of patients with atrial fibrillation and chronic kidney disease in light of the latest guidelines

Abstract

REVIEW ARTICLE Management of patients with AF and CKD 353link with AF because it leads not only to anatomic and metabolic changes in the cardiovascular system but also to alterations in the endocrine and nervous systems, hematopoiesis, and inflammatory response, which increases the risk of AF.2 The overload of the extracellular fluid might lead to left ventricular hypertrophy and ventricular diastolic dysfunction, which causes atrial remodeling, a well-known pathogenesis of AF. 6AF frequently occurs in renal failure population and ranges from 19% to 24%, rising to 27% in patients with end-stage renal disease (ESRD). 5,7In the Framingham Heart Study, 8 the prevalence of AF in patients with CKD was 15-fold higher than that in the general population, while in the Chronic Renal Insufficiency Cohort study, 9 AF was Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1% to 2% of the general population. 1,2 The percentage of patients with AF increases with age from 0.14% in those younger than 50 years old, 4% in those between 60 and 70 years old, to 14% in those over 80 years old. 3 AF is a well-known risk factor for cardiovascular morbidity, especially thromboembolic complications (including ischemic stroke), and mortality that resulted in 112 000 deaths in 2013, compared with 29 000 deaths in 1990. 1,2,4During the past 10 years, chronic kidney disease (CKD) has been also identified as a major risk factor for cardiovascular morbidity and mortality, with rapidly increasing prevalence.5 Impairment of kidney function has a well-established ABSTRACTAtrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD), and the rate reaches even 30% in patients with end-stage renal disease (ESRD). Patients with AF and CKD have a significantly higher risk of thrombotic complications, particularly ischemic stroke, and at the same time, a higher bleeding risk (proportionally to the grade of renal failure). In addition, AF and CKD share a number of comorbidities and risk factors, which results in increased mortality rates. Moreover, disturbances in hemostasis are common complications of kidney disease. Their occurrence and severity correlate with worsening renal function, including ESRD. At present, the incidence of bleeding is declining, while thrombotic complications have become the predominant cause of mortality. Prophylactic antithrombotic treatment reduces the rate of stroke and other thrombotic complications. Vitamin K antagonists (VKAs) have long been used in anticoagulant therapy, and more recently, non-vitamin K oral anticoagulants (NOACs) have been introduced, which are direct thrombin inhibitors. NOACs are a valuable anticoagulant option in this group of patients as long as a summary of product characteristics is followed. They are at least as effective as warfarin, while being safer, especially when it comes to intracranial hemorrhage. Renal function should be evaluated before initiation of NOACs and reevaluated when clinically indicated. Importantly, disturb...

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

“…Moreover, monitoring of the drug effects is also difficult and not routinely established so far. 66,67 Drug and food interactions DOACs have only a few pharmacokinetic interactions of mild character with other commonly administered drugs. 68 Rivaroxaban and dabigatran are substrates of the efflux transporter P-glycoprotein which is induced by rifampicin and inhibited by ketoconazole and dronedarone.…”

Do patients with a history of systemic embolism have better compliance in International Normalized Ratio control?

“…Although NOACs are nowadays the preferred therapeutic option according to European Society of Cardiology guidelines, patients with markedly reduced renal function, especially with eGFR < 30 ml/min, benefit from VKA treatment [35] . Also patients after kidney transplantation are limited to use of VKA [36,37,38] . From AF -atrial fibrillation Table 3.…”

Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery – a 867 Patient Study

“…In population with non-valvular AF like ours decreased eGFR was associated with permanent type of AF and with higher CHA 2 DS 2 VASc and HAS-BLED score. Among valvular AF patients there were no differences in type of AF between patients with and without CKD while there was significant correlation between CKD and AF perpetuation in non-valvular population [19]. …”