Title:The Problem of Atrial Fibrillation in Patients with Chronic Kidney Disease
Volume: 14
Issue: 3
Author(s): Beata Franczyk, Anna Gluba-Brzózka, Aleksandra Ciałkowska-Rysz, Maciej Banach and Jacek Rysz
Affiliation:
Keywords:
Atrial fibrillation, chronic kidney disease, end-stage renal disease, risk factors, thrombosis.
Abstract: Chronic kidney disease (CKD) is associated with the risk of multiple life-threatening complications
such as: progression to chronic renal failure and cardiovascular disease including coronary
heart disease, heart failure and peripheral arterial disease. Also, atrial fibrillation (AF) is common in
this group of patients. Factors contributing to the occurrence of AF in patients undergoing dialysis include:
age, presence of coronary heart disease, echocardiographic abnormalities (low ejection fraction, atrial enlargement,
valvular calcification, left ventricular hypertrophy), heart failure, chronic obstructive pulmonary disease, hypertension,
stroke, malnutrition (low levels of albumin, total cholesterol and high-density lipoprotein (HDL), secondary hyperparathyroidism,
low predialysis systolic blood pressure, duration of renal replacement therapy as well as the method of renal replacement
therapy (more frequent in haemodialysis patients). The optimal management of thromboprophylaxis in patients
with CKD and AF is complex due to the fact that in patients with CKD many physiologic mechanisms are altered which
lead to substantial changes in haemostasis and thus this group of patients is characterized by an increased risk of thrombotic
and haemorrhagic complications. Recommendations concerning the treatment of patients with AF do not include
guidelines on how to manage patients with advanced CKD, due to the lack of large randomized trials assessing the efficacy
and benefits of drugs in these patients. Patients with CKD and permanent, persistent, and paroxysmal AF ought to be
treated as a group with high risk of bleeding and ischaemic stroke. In case of patients with no or only one moderate risk
factors, it seems that anticoagulation with antiplatelet drugs can be considered as efficient therapy, while in patients with ≥2 risk factors an oral anticoagulation therapy may be used. During long-term treatment, the international normalized ratio
(INR) must be controlled at least every 14 days and adjusted within a target range of 2.0-2.5. Moreover, renal function
should be evaluated before initiation of direct thrombin or factor Xa inhibitors and re-evaluated when clinically indicated
and at least annually.
