Key result
Oral anticoagulation reduces stroke morbidity and mortality in non-dialysis CKD with AF despite bleeding risks.
This review highlights the clinical impact of chronic kidney disease on stroke prevention and management in patients with atrial fibrillation.
Highlights elevated stroke/bleeding risks in AF-CKD; leaves open net OAC benefit without dedicated RCTs.
The increasing burden of Chronic Kidney Disease (CKD) is highly relevant to cardiologists, as cardiovascular mortality is 10-30 times higher amongst people with End-stage Renal Disease (ESRD), comparing with general population. One of the commonest associations is the increased frequency of atrial fibrillation (AF) amongst those experiencing CKD. Overall, we know that AF is the most common cardiac arrhythmia. AF leads to a substantial risk of mortality and morbidity, from stroke and thromboembolism, heart failure, reduced cognitive function and impaired quality of life. However, most clinical trials in AF (for example, for stroke prevention in AF with anticoagulation therapy) have largely excluded patients with significant renal impairment. In this review article, we will focus on stroke prevention in AF, and the clinical impact of CKD and its implications for management.
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Lau et al. (2014) conducted a review in Atrial Fibrillation and Chronic Kidney Disease. Oral anticoagulants was evaluated. Oral anticoagulation in non-dialysis dependent chronic kidney disease patients with atrial fibrillation can reduce morbidity and mortality from stroke, though careful risk stratification is required due to elevated bleeding risks.
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