Atrial fibrillation in patients with chronic kidney disease: features of pathogenesis and treatment

Abstract

Atrial fibrillation (AF) is the most commonly diagnosed cardiac arrhythmia in adults, the frequency of which increases in patients with chronic kidney disease (CKD). The substrate for the development of AF is atrial cardiomyopathy, which includes structural, electrophysiological and molecular remodeling of the atria. AF, in turn, can initiate and accelerate the progression of CKD. Such a bidirectional relationship causes a frequent combination of these two conditions, leading to both a prothrombotic state and an increased risk of bleeding. In patients with CKD, the pharmacokinetics of drugs used in AF are changing, what limits their use in CKD S4/S5. If previously patients with CKD S4-5 were excluded from randomized clinical trials (RCTs) on treatment strategies for AF, a number of such studies on their management have been published to date. The purpose of the article is to review existing ideas about the features of the pathogenesis of AF in CKD and strategies of recent years for the treatment of AF with advanced stages of CKD.