Pathophysiology of atrial fibrillation and chronic kidney disease

Abstract

Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related conditions with shared risk factors. The growing prevalence of both AF and CKD indicates that more patients will suffer from concurrent conditions. There are various complex interlinking mechanisms with important implications for the management of these patients. Furthermore, there is uncertainty regarding the use of oral anticoagulation in AF and CKD that is reflected by a lack of consensus between international guidelines. Therefore, the importance of understanding the implications of co-existing AF and CKD should not be underestimated. In this review, we discuss the pathophysiology and association between AF and CKD, including the underlying mechanisms, risk of thromboembolic and bleeding complications, influence on stroke management, and evidence surrounding the use of oral anticoagulation for stroke prevention.

New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction

“…На этом фоне недостатками варфарина является медлен-ное развитие эффекта, длинный период полувыведения и наличие множественных лекарственных взаимодействий [26]. Результаты ретроспективных исследований применения антагонистов витамина К в популяциях пациентов с ФП и низкой функцией почек являются сомнительными даже в отношении снижения риска инсультов [27]. В частности, в Великобритании среди пациентов с ФП и ХБП (рСКФ <50 мл/ мин/1,73 м…”

“…Среди пациентов с ФП и ХБП С3-С4 стадий (n=14432) более стремительное снижение СКФ в течение 5 лет наблюдалось на фоне документированного приема варфарина (-1,5 мл/мин/1,73 м 2 , p=0,002), чем при его отсутствии [33]. С другой стороны, участие почек в выведении прямых пероральных антикоагулянтов (ППОАК) на 27-80% в зависимости от конкретного препарата так же может влиять на эффективность и безопасность указанных лекарственных средств [27]. Например, концентрация дабигатрана в плазме крови между приемами препарата является вариабельным показателем и увеличивается у пациентов с ХБП С3b стадии, особенно, в пожилом возрасте и при наличии сопутствующих заболеваний [34].…”

Outcomes in VKA‐treated patients with atrial fibrillation and chronic kidney disease: Clinical trials vs ‘real‐world’

“…Atrial fibrillation (AF) and chronic kidney disease (CKD) are increasingly prevalent conditions that commonly co‐exist 1 . Each is associated with an elevated thromboembolic risk 2,3 and this risk is compounded when both disorders are present in a patient 4‐6 .…”

Highlights of American Heart Association Scientific Sessions 2020: a virtual experience

“…In a new first-of-its-kind international outcomes trial, TIPS-3 , involving more than 5000 patients with an intermediate CVD risk but no known CVD, treatment with a polypill formulation (simvastatin, atenolol, ramipiril, and hydrochlorothiazide), plus aspirin led to a lower incidence of cardiovascular events. In VITAL-Rhythm trial, involving more than 20 000 patients, treatment with vitamin D3, Omega-3 fatty acids, or a combination had no effect on the incidence of atrial fibrillation (AF), the most common cardiac arrhythmia and a major cause of morbidity and mortality, 1 over a median treatment duration of 5.3 years. Likewise, in the AF field, SEARCH-AF study demonstrated that enhanced cardiac rhythm monitoring detected a higher incidence of post-operative AF after cardiac surgery, as compared to the usual care, in those who had no history of AF but had a high risk of stroke.…”

“…One month therapy seemed preferential for stable PCI, whereas 6–12 months DAPT appeared preferential for patients with acute coronary syndromes ( P for interaction = 0.013). Finally, the RIVER trial, an open-label study, showed that rivaroxaban is non-inferior to warfarin, which is currently the standard of care anticoagulant, 1 for prevention of thromboembolic events among patients with AF and a bioprosthetic mitral valve.…”