title: Understanding and Managing Atrial Fibrillation in Patients with Kidney Disease.
abstract: Chronic kidney disease (CKD) is on the rise due to the increased rate of related comorbidities such as diabetes and hypertension. Patients with CKD are at higher risk of cardiovascular events and atrial fibrillation is more common in this patient population. It is estimated that the prevalence of chronic atrial fibrillation in patients with CKD is two to three times higher than general population. Furthermore, patients with CKD are less likely to stay in sinus rhythm. Atrial fibrillation presents a major burden in this population due to difficult treatment decisions in the setting of a lack of evidence from randomized clinical trials. Patients with CKD have higher risk of stroke with more than half having a CHADS2 score ≥ 2. Anticoagulation have been shown to significantly decrease embolic stroke risk, however bleeding complications such as hemorrhagic stroke is twofold higher with warfarin. Although newer novel anticoagulation drugs have shown promise with lower intracranial hemorrhage risk in comparison to warfarin, lack clinical trial data in CKD and the unavailability of an antidote remains an issue. In this review, we discuss the treatment options available including anticoagulation and the evidence behind them in patients with chronic kidney disease suffering from atrial fibrillation.
authors.affiliation: Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI.
authors.forename: Yazan
authors.initials: Y
authors.lastname: Khouri
authors.affiliation: Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI.
authors.forename: Tiona
authors.initials: T
authors.lastname: Stephens
authors.affiliation: Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ayuba
authors.affiliation: Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI.
authors.forename: Hazim
authors.initials: H
authors.lastname: AlAmeri
authors.affiliation: Oakwood Health System, Oakwood Hospital and Medical Center, Department of Cardiovascular Medicine, Dearborn, MI.
authors.forename: Nour
authors.initials: N
authors.lastname: Juratli
authors.affiliation: Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, The Heart Hospital, Plano, TX.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough