Key result
DOACs offer better nephroprotection and safety than VKAs in AF with advanced CKD.
Why the study?
Choosing optimal anticoagulation in patients with AF and advanced CKD or ESRD remains challenging, and data in patients on peritoneal dialysis are sparse.
Do direct oral anticoagulants improve safety, efficacy, and renal outcomes compared to vitamin K antagonists in patients with atrial fibrillation and advanced chronic kidney disease, particularly those on peritoneal dialysis?
Do direct oral anticoagulants improve safety, efficacy, and renal outcomes compared to vitamin K antagonists in patients with atrial fibrillation and advanced chronic kidney disease, particularly those on peritoneal dialysis?
DOACs offer potential nephroprotective and safety advantages over warfarin in patients with AF and advanced CKD, highlighting an urgent need for dedicated randomized trials in the peritoneal dialysis population.
Supports DOAC preference over VKAs in AF with advanced CKD; leaves open peritoneal dialysis management pending dedicated RCTs.
Atrial fibrillation (AF) and chronic kidney disease (CKD) are two closely related pathophysiologically interconnected conditions, sharing common risk factors and resulting in poor clinical outcomes when coexisting. In patients with end-stage renal disease (ESRD) on renal replacement therapy, AF significantly complicates clinical management, as these patients have a doubled risk of death, stroke, and bleeding. Choosing the optimal anticoagulant strategy remains a major challenge, with direct oral anticoagulants (DOACs) emerging as a potentially superior alternative to vitamin K antagonists (VKAs), especially due to their renoprotective profile. However, data in patients on peritoneal dialysis (PD) remain sparse, constituting a significant gap in the scientific literature. This review examines the current state of evidence on anticoagulation in patients with AF and advanced CKD, with a particular focus on new therapeutic perspectives in the PD population.
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Franculli et al. (2026) conducted a review in Atrial fibrillation and chronic kidney disease. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated. Direct oral anticoagulants offer significant advantages over vitamin K antagonists in nephroprotection and safety for patients with atrial fibrillation and advanced chronic kidney disease.
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