Chronic kidney disease and atrial fibrillation

A.I. Dyadik, N.F. Yarovaya, Y.V. Suliman, S.R. Zborowskyy, V.I. Merkurev, T.E. Kugler

Atrial fibrillation (AF) is one of the most frequently encountered and sustained cardiac arrhythmia in clinical practice, including, among patients with chronic kidney disease (CKD). Research evidence suggests that the prevalence and incidence of AF is higher among patients with CKD than in the absence of renal disease, and that the risk of AF increases in parallel with the progression of renal insufficiency. Potential mechanisms of AF in patients with CKD may include increased sympathetic tone, activation of the renin-angiotensin-aldosterone system, myocardial remodeling, various electrolyte disturbances and an increase in C-reactive protein levels as a marker of systemic inflammatory response. The co-occurrence of CKD and AF is characterized by a high risk of thromboembolic complications. To date, there has been no reliable evidence on the efficacy and safety of antithrombotic therapy in patients with CKD. Hemodialysis is associated with an increased AF risk. Current evidence on the risk-benefit ratio of anticoagulation therapy in patients on hemodialysis is inconsistent and needs to be further investigated.

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