Atrial Fibrillation and Chronic Kidney Disease in Hypertension: A Common and Dangerous Triad
Dimitris Tsiachris, Costas Tsioufis, Patrizio Mazzone, Niki Katsiki and Christodoulos Stefanadis
Affiliation: 3 Kolokotroni Street, 15236, P. Penteli, Athens, Greece.
Keywords: Atrial fibrillation, anticoagulants, chronic kidney disease, hypertension.
Hypertension (HTN) and chronic kidney disease (CKD) often coexist sharing common pathophysiological
factors that both in combination and separately induce fibrotic changes in the heart provoking
atrial fibrillation (AF). AF, per se, is associated with a 4- to 5-fold increased risk of stroke and a 2-fold increased
risk of all-cause death. The co-existence of AF with HTN and renal dysfunction considerably increases
morbidity and mortality. Management of AF in hypertensive patients with CKD is complex and multidisciplinary,
since these patients have both a prothrombotic state and a coagulopathy with an increased tendency for bleeding. Novel
oral anticoagulants such as dabigatran, rivaroxaban and apixaban offer better efficacy and safety especially in patients
without optimal treatment with vitamin K antagonists.
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