title: Management of atrial fibrillation in chronic kidney disease: double trouble.
abstract: Chronic kidney disease (CKD) has a very well-established link with cardiovascular disease. Below stage 3 CKD (glomerular filtration rate <60 mL/min), there is a progressive increase in both total mortality and cardiovascular-specific mortality as kidney function declines; indeed, it is more likely for a patient with CKD stage 3 to die of cardiovascular disease than to progress to CKD stage 4 and beyond. Arrhythmia is particularly common in patients with CKD. Depending on the study and measurement used, the prevalence of patients with CKD with chronic atrial fibrillation (AF) is quoted at 7% to 18%, rising to 12% to 25% for those older than 70 years. These rates are up to 2 to 3 times higher than in the general population. Of all patients with AF, 10% to 15% will have CKD. However, not all standard rate and rhythm methods are suitable for this population and those that are tend to be less effective. Meanwhile, anticoagulation has long been a thorny subject, with much conflicting evidence around the balance between bleeding and stroke risk. To help clarify this, we first highlight the challenges of performing evidence-based medicine in the patient with renal disease, and then review recent and emerging research to suggest an approach to the management of patients with renal disease who have AF. We also review the potential role of the different new oral anticoagulant drugs in CKD.
authors.affiliation: Department of Cardiology, King's Health Partners Academic Health Sciences Centre, London, United Kingdom.
authors.forename: Camus
authors.initials: C
authors.lastname: Nimmo
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D019317:Evidence-Based Medicine; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy; D020521:Stroke / Q000517:prevention & control
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants