Atrial fibrillation affects up to 27% of long-term hemodialysis patients, and two-year death rates for chronic kidney disease patients after stroke range between 55% and 74%.
This review highlights the high prevalence of AF and stroke risk in CKD patients and discusses oral anticoagulation strategies, including DOACs, for this undertreated population.
Due to several unfavorable epidemiological changes, chronic kidney disease (CKD) and treatment of its associated cardiovascular morbidity have become a worldwide problem. Thus, atrial fibrillation (AF) is the most common arrhythmia and frequently associated with renal impairment: prevalence for AF is up to 27% in long-term hemodialysis patients and in general more than 25% in all CKD patients 70 years and older. Thromboembolism and stroke are the major complications of AF. Two-year death rates for CKD patients after stroke range between 55% and 74%. Although treatment of AF in the general population is well defined, patients with CKD and AF are often undertreated due to lack of studies and guidelines. In this review recent data concerning incidence and prevalence of AF, stroke, and major bleedings in CKD patients are presented. Particular attention is paid to the available data about the different types of oral anticoagulation therapy with regard to CKD stage, including the new oral anticoagulant drugs dabigatran, rivaroxaban, and apixaban. Stratification algorithms for stroke risk in general, and individualized risk stratification for oral anticoagulation in CKD patients are discussed in detail.
Engelbertz et al. (Sat,) conducted a review in Atrial Fibrillation and Chronic Kidney Disease. Oral anticoagulation was evaluated. Atrial fibrillation affects up to 27% of long-term hemodialysis patients, and two-year death rates for chronic kidney disease patients after stroke range between 55% and 74%.