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Published on: February 26, 2013
Anticoagulation in patients with end-stage kidney disease and atrial fibrillation: a national population-based study
Deok-Gie Kim1, Sung Hwa Kim2,3, Sung Yong Park4
1Department of Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Oral anticoagulant (OAC) use in patients with end-stage kidney disease (ESKD) and atrial fibrillation (AF) is associated with reduced mortality and stroke risk. These findings suggest OACs improve outcomes in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- High and increasing prevalence of atrial fibrillation (AF) in end-stage kidney disease (ESKD) patients.
- Insufficient and conflicting evidence on oral anticoagulant (OAC) use in this population.
Purpose of the Study:
- To evaluate the association between OAC use and clinical outcomes in patients with ESKD and AF.
Main Methods:
- Retrospective cohort study using the Korea National Health Insurance System (2007-2017).
- Included patients diagnosed with AF after ESKD onset.
- Primary outcome: all-cause death. Secondary outcomes: ischemic stroke, major bleeding hospitalization, MACE.
- Propensity score matching (PSM) and landmark analysis compared OAC users and non-users.
Main Results:
- OAC prescriptions increased significantly, with a rise in direct OACs.
- After PSM, OAC users showed lower risks of all-cause death (HR 0.67), ischemic stroke (HR 0.61), and MACE (HR 0.70).
- No increased risk of major bleeding hospitalization (HR 0.99) was observed with OACs.
- Direct OACs, unlike warfarin, were linked to reduced death and bleeding hospitalization.
Conclusions:
- OACs are associated with reduced all-cause death, ischemic stroke, and MACE in ESKD patients with AF.
- Direct OACs may offer a favorable risk-benefit profile in this cohort.
Background:
The prevalence of atrial fibrillation (AF) in patients with end-stage kidney disease (ESKD) is high and increasing. However, evidence regarding oral anticoagulant (OAC) use in these patients is insufficient and conflicting.
Methods:
This retrospective cohort study included patients in the Korea National Health Insurance System diagnosed with AF after ESKD onset from January 2007 to December 2017. The primary outcome was all-cause death. Secondary outcomes were ischaemic stroke, hospitalization for major bleeding and major adverse cardiovascular events (MACE). Outcomes were compared between OAC users and non-users using 6-month landmark analysis and 1:3 propensity score matching (PSM).
Results:
Among patients with ESKD and AF, the number of prescribed OACs increased 2.3-fold from 2012 (n = 3579) to 2018 (n = 8341) and the proportion of direct OACs prescribed increased steadily from 0% in 2012 to 51.4% in 2018. After PSM, OAC users had a lower risk of all-cause death {hazard ratio [HR] 0.67 [95% confidence interval (CI) 0.55-0.81]}, ischaemic stroke [HR 0.61 (95% CI 0.41-0.89)] and MACE [HR 0.70 (95% CI 0.55-0.90)] and no increased risk of hospitalization for major bleeding [HR 0.99 (95% CI 0.72-1.35)] compared with non-users. Unlike warfarin, direct OACs were associated with a reduced risk of all-cause death and hospitalization for major bleeding.
Conclusions:
In patients with ESKD and AF, OACs were associated with reduced all-cause death, ischaemic stroke and MACE.
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