Related Experiment Video

Updated: May 5, 2026

Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

15.4K

Inflammation, Endothelial Dysfunction, and Platelet Dysregulation in Atrial Fibrillation with Chronic Kidney Disease:

Maria-Daniela Tanasescu1, Andrei-Mihnea Rosu2, Alexandru Minca1

  • 1Department of Semiology-Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania.

Life (Basel, Switzerland)
|May 4, 2026
PubMed

Insights

Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) face high risks of stroke and bleeding. Current treatments inadequately address shared biological pathways, necessitating a biology-informed approach to anticoagulation.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Biology

Background:

  • Atrial fibrillation (AF) and chronic kidney disease (CKD) commonly coexist, increasing risks of thromboembolic and bleeding events.
  • Current anticoagulation dosing based on creatinine clearance may not fully address the complex pathophysiology of thrombohemorrhagic instability in this population.

Purpose of the Study:

  • To review recent evidence on the bidirectional cardio-renal axis in AF and CKD.
  • To focus on shared pathophysiological mechanisms including inflammation, endothelial dysfunction, and platelet dysregulation.
  • To propose a shift towards a biology-informed anticoagulation strategy.

Main Methods:

  • A narrative review synthesizing mechanistic and translational evidence.
  • Structured literature search of PubMed/MEDLINE, Scopus, and Web of Science (2018-2026).
  • Manual review of key references and guidelines.

Main Results:

  • Shared mechanisms in AF and CKD include inflammatory cytokine activation, oxidative stress, glycocalyx degradation, and platelet dysfunction.
  • These factors create a disrupted vascular interface leading to both stroke and bleeding.
  • Renal trajectory and biomarkers indicate dynamic and heterogeneous risk in advanced CKD.

Conclusions:

  • Anticoagulation decisions in AF with CKD should move beyond static filtration models.
  • A biology-informed approach integrating renal dynamics, vascular phenotype, and clinical context is needed.
  • This approach aims to optimize the balance between thromboembolic protection and bleeding safety.

Keywords:
anticoagulationatrial fibrillationcardio–renal axischronic kidney diseaseendothelial dysfunctioninflammationplatelet dysfunctionthrombohemorrhagic paradox

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