Atrial fibrillation (AF) and chronic kidney disease (CKD) are disorders
with increasing prevalence. The presence of CKD increases the risk of incident
AF and vice versa, and the presence of AF may accelerate CKD progression.
Nearly a third of patients with established CKD also have AF, whilst half
of AF patients may have some degree of renal dysfunction. Both AF and CKD
are associated with increased cardiovascular morbidity and mortality, including
significantly increased risk of stroke or systemic embolism. Oral anticoagulant
therapy (OAC), either with vitamin K antagonists or with non-vitamin K oral
anticoagulants (NOACs) is essential to optimise prevention of stroke and systemic
embolism in AF patients with one or more stroke risk factors, and
NOACs are more convenient and generally safer than vitamin K antagonists mostly due to consistently
reduced risk of intracranial bleeding.
The use of OAC must be balanced against the risk of OAC-related bleeding, which depends on
the presence of bleeding risk factors. Renal failure is a well-established bleeding risk factor and
renal function should be routinely assessed in all patients presenting with AF. Since the risk of
bleeding increases in parallel with CKD severity, the clinical decision to use OAC in AF patients
with severe CKD may be challenging. In this review article we summarize the OAC agents currently
used in clinical practice and discuss the role of NOACs for stroke prevention in patients
with AF and CKD.
Keywords: Atrial fibrillation, chronic kidney disease, renal failure, stroke prevention, oral anticoagulation, vitamin
K antagonists, warfarin, non-vitamin K antagonist oral anticoagulants.
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