What question did this study set out to answer?

To investigate the prevalence and impact of chronic kidney disease in older patients with atrial fibrillation.

January 10, 2026BMC Geriatrics0 citationsOpen Access

The prevalence and burden of chronic kidney disease, patterns of anticoagulation prescribing, and major bleeding risk in older adults with atrial fibrillation

HAHawa O. AbuUniversity of Massachusetts Chan Medical School FCFelipe Fernandez del CastilloReliant Medical Group WWWeijia WangMarshfield Clinic

Key Result

Older adults with atrial fibrillation and severely impaired kidney function have a high risk of major bleeding, necessitating a holistic approach to their care.

Key Points

To investigate the prevalence and impact of chronic kidney disease in older patients with atrial fibrillation.
Review of management strategies for older adults with AF and CKD
Assessment of anticoagulation prescribing patterns
Evaluation of major bleeding risks related to anticoagulation treatments
Older adults with atrial fibrillation and CKD have a higher burden of frailty and dependence for care.
Major bleeding risks are significantly elevated in patients with severely impaired kidney function.
Polypharmacy is prevalent among patients, complicating treatment plans.

Structured PICO

Does severe chronic kidney disease increase the risk of major bleeding in older adults with atrial fibrillation?

Population

1,244 older adults (age ≥ 65 years) with atrial fibrillation and CHA2DS2-VASc score ≥ 2, mean age 75, 48% women, 86% White, from clinics in Massachusetts and Georgia. Excluded patients scheduled for high-bleeding-risk invasive procedures, with other indications for oral anticoagulation, or absolute contraindications.

Intervention

Severe chronic kidney disease / kidney failure (eGFR ≤ 29 mL/min/1.73m²)

Comparator

Normal kidney function (eGFR ≥ 90 mL/min/1.73m²)

Outcome

Major bleeding events at 2-years follow-up, defined by the International Society on Thrombosis and Hemostasis (ISTH) scalesafety

In older adults with atrial fibrillation, severe chronic kidney disease is associated with a significantly increased risk of major bleeding, highlighting the need for careful stroke prophylaxis management.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

In managing older patients with AF and comorbid CKD, healthcare providers should be increasingly aware of the increased burden of frailty, dependence for care, multimorbidity, polypharmacy, and the high risk of major bleeding especially among those with severely impaired kidney function. This finding emphasizes the need for a more holistic and multidisciplinary approach to stroke prophylaxis in older adults with AF and comorbid CKD.

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