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Atrial fibrillation and chronic kidney disease conundrum: an update

Laura Tapoi1, Carina Ureche2,3, Radu Sascau1,4

  • 1Institute of Cardiovascular Disease "Prof. Dr. George I.M. Georgescu", Iasi, Romania.

Journal of Nephrology
|July 20, 2019
PubMed

Insights

Atrial fibrillation (AF) and chronic kidney disease (CKD) worsen each other, increasing risks. Optimal treatment for these patients remains unclear due to limited research, highlighting the need for new strategies.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Medicine

Background:

  • Atrial fibrillation (AF) is a common arrhythmia, frequently seen in patients with chronic kidney disease (CKD).
  • CKD patients have elevated cardiovascular risk, which is further increased by AF, complicating prognosis.
  • The interplay between AF and CKD is bidirectional, with kidney disease predisposing to AF and AF accelerating CKD progression.

Purpose of the Study:

  • To reinforce understanding of the symbiotic relationship between AF and CKD.
  • To summarize current therapeutic approaches for CKD patients with AF.
  • To highlight potential novel therapeutic strategies for this population.

Main Methods:

  • This review synthesizes existing data and expert consensus.
  • It addresses the lack of randomized controlled trials (RCTs) in this specific patient group.
  • Focuses on the challenges in managing bleeding and thrombotic risks, particularly with anticoagulation in end-stage renal disease (ESRD).

Main Results:

  • The combined presence of AF and CKD significantly elevates cardiovascular complications and mortality.
  • Managing anticoagulation in CKD patients, especially those with ESRD, presents a complex balance between thrombotic and bleeding risks.
  • Decisions regarding rate versus rhythm control are largely based on consensus due to scarce RCT evidence.

Conclusions:

  • The bidirectional relationship between AF and CKD necessitates tailored management strategies.
  • Further research, including RCTs, is crucial to establish evidence-based guidelines for managing AF in CKD patients.
  • Exploring novel therapeutic avenues is essential to improve outcomes for this high-risk population.

Keywords:
Atrial fibrillationChronic kidney diseaseHemodialysisOral anticoagulant therapy

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