Pathophysiology of atrial fibrillation and chronic kidney disease

• Published in: Cardiovascular research Vol. 117; no. 4; pp. 1046 - 1059
• Main Authors: Ding, Wern Yew, Gupta, Dhiraj, Wong, Christopher F, Lip, Gregory Y H
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 21.03.2021
• Subjects: Action Potentials; Administration, Oral; Animals; Anticoagulants - administration & dosage; Atrial Fibrillation - blood; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Blood Coagulation; Heart Conduction System - physiopathology; Heart Rate; Humans; Kidney - physiopathology; Prognosis; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Risk Assessment; Risk Factors; Stroke - epidemiology; Stroke - physiopathology; Stroke - prevention & control; Thromboembolism - epidemiology; Thromboembolism - physiopathology; Thromboembolism - prevention & control; Vitamin K - antagonists & inhibitors; Kidney impairment; Stroke; Warfarin; Pathophysiology; Atrial fibrillation; Renal failure; NOAC; Chronic kidney disease; Anticoagulation; Thromboembolism; VKA; Bleeding
• ISSN: 0008-6363; 1755-3245; 1755-3245
• DOI: 10.1093/cvr/cvaa258

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 (OAC) 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 thrombo-embolic and bleeding complications, influence on stroke management, and evidence surrounding the use of OAC for stroke prevention.