Atrial fibrillation and chronic kidney disease: correction of treatment


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Abstract

Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmias, complicating all cardiac and many noncardiac diseases. The probability of combination of AF and chronic kidney disease (CKD) is very high: it is believed that the prevalence of CKD in the general population is 10%, and AF occurs in 15-20% of patients with CKD. Two-way communication of AF and renal dysfunction is shown in several studies that have demonstrated that the presence of AF increases the likelihood of CKD, and, on the contrary, in patients with impaired renal function, likelihood of developing AF is increased. AF and CKD association is explained by the existence of common risk factors (obesity, arterial hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular diseases), and pathogenesis (inflammation, oxidative stress, hyper-activation of the RAAS). One of the mechanisms of pathophysiological relationships of AF and CKD includes changes in echocardiogram parameters, especially those that characterize the anatomy and function of the left atrium. All AF patients receiving oral anticoagulants require assessment of renal function at least once a year to identify CKD (IIa, B). The most significant in practical terms, features of combination of AF and CKD are associated with changes in the pharmacokinetics of antiarrhythmic drugs and anticoagulants in patients with impaired renal function, which may require correction of the dose of medication. However, the focus of attention of practitioners is generally offset by the fact that renal dysfunction is one of the points of HAS-BLED scale, ie, its presence in AF patient increases the risk of hemorrhagic complications and influence decisionmaking on the appointment of anticoagulants. It should be noted that assessment of the likelihood of bleeding according to this scale implicates renal failure as a serum creatinine greater than 200 mmol/l (instead of decline in GFR), permanent dialysis or kidney transplantation.

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About the authors

Aleksandr V. Melekhov

N.I. Pirogov Russian national research medical university

Email: avmelekhov@gmail.com
PhD, assistant professor of the Department of hospital therapy №2

References

  1. Колбин А.С., Татарский Б.А., Бисерова И.Н., Загородникова К.А., Балыкина Ю.Е., Проскурин М.А., Белоусов Д.Ю. Социально-экономическое бремя мерцательной аритмии в Российской Федерации. Клиническая фармакология и терапия. 2010;19(4):17-22. [Kolbin A.S., Tatarsky B.A., Biserova I.N., Zagorodnikova K.A., Balykin Yu.Ye., Proskurin M.A., Belousov D.Yu. Socio-economic burden of atrial fibrillation in the Russian Federation. Clinical pharmacology and therapeutics. 2010;19(4):17-22 (in Russ.)]
  2. Сулимов В.А., Голицын С.П., Панченко Е.П., Попов С.В., Ревишвили А.Ш., Шубик Ю.В., Явелов И.С. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА и АССХ. Российский кардиологический журнал. 2013;4(102), приложение 3:100. [Sulimov V.A., Golitsyn S.P., Panchenko Ye.P., Popov S.V., Revishvili A.Sh., Shubik Yu.V., Yavelov I.S. Diagnostics and treatment of atrial fibrillation. Recommendations RKO, VNOA and ASSH. Russian journal of cardiology. 2013;4(102), Suppl. 3:100. (in Russ.)]
  3. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B., Castella M., Diener H.C., Heidbuchel H., Hendriks J., Hindricks G., Manolis A.S., Oldgren J., Popescu B.A., Schotten U., Van Putte B., Vardas P. Authors/Task Force Members.; Document Reviewers: 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO). Eur. Heart J. 2016;37(38):2893.
  4. Смирнов А.В., Шилов Е.М., Добронравов В.А., Каюков И.Г., Бобкова И.Н., Швецов М.Ю., Цыгин А.Н., Шутов А.М. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Национальные рекомендации. СПб, 2012. ISBN 978-5-93356-129-3. [Smirnov A.V., Shilov Ye.M., Dobronravov V.A., Kayukov I.G., Bobkova I.N., Shvetsov M.Yu., Tsygin A.N., Shutov A.M. Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches. The national guidelines. Saint-Petersburg, 2012. ISBN 978-5-93356-129-3 (in Russ.)]
  5. Hart R.G., Eikelboom J.W., Brimble K.S., McMurtry M.S., Ingram A.J. Stroke prevention in atrial fibrillation patients with chronic kidney disease. Can. J. Cardiol. 2013;29:71-8.
  6. Мелехов А.В., Гендлин Г.Е., Никитин И.Г., Алексеева Е.М., Дадашова Э.Ф., Захарова И.И., Варенцов С.И. Практика ведения больных с фибрилляцией предсердий: реальная ситуация на примере Московского регистра в период 2009-2015 гг. Сердце: журнал для практикующих врачей. 2017;16(1):75-80. [Melekhov A.V., Gendlin G.Ye., Nikitin I.G., Alekseeva Ye.M., Dadashova E.F., Zakharova I.I., Varentsov I.S. the Practice of management of patients with atrial fibrillation: the real situation on the example of the Moscow register in 2009-2015. Heart: journal for practitioners. 2017;16(1):75-80 (in Russ.)]
  7. Watanabe H., Watanabe T., Sasaki S., Nagai K., Roden D.M., Aizawa Y. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. Am. Heart J. 2009;158(4):629-36.
  8. Iguchi Y., Kimura K., Kobayashi K., Aoki J., Terasawa Y., Sakai K., Uemura J., Shibazaki K. Relation of atrial fibrillation to glomerular filtration rate. Am. J. Cardiol. 2008;102(8):1056-9.
  9. Гендлин Г.Е., Резник Е.В., Сторожаков Г.И., Мелехов А.В., Ускова О.В., Федоровская Т.В. Взаимосвязь фибрилляции предсердий и дисфункции почек у больных с хронической сердечной недостаточностью. Нефрология и диализ. 2010;4(12):254-61 [ (in Russ.)]
  10. Nakanishi K., Jin Z., Russo C., Homma S., Elkind M.S., Rundek T., Tugcu A., Sacco R.L., Di Tullio M.R. Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur. J. Prev. Cardiol. 2017;24(4):392-8.
  11. Go A.S., Fang M.C., Udaltsova N., Chang Y., Pomernacki N.K., Borowsky L., Singer D.E. Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation. 2009;119(10):1363-9.
  12. Olesen J.B., Lip G.Y., Kamper A.L., Hommel K., Kober L., Lane D.A., Lindhardsen J., Gislason G.H., Torp-Pedersen C. Stroke and bleeding in atrial fibrillation with chronic kidney disease. N. Engl. J. Med. 2012;367:625-35.
  13. Albertsen I.E., Rasmussen L.H., Overvad T.F., Graungaard T., Larsen T.B., Lip G.Y. Risk of stroke or systemic embolism in atrial fibrillation patients treated with warfarin: A systematic review and meta-analysis. Stroke. 2013;44:1329-36.
  14. Hart R.G., Pearce L.A., Asinger R.W., Herzog C.A. Warfarin in atrial fibrillation patients with moderate chronic kidney disease. Clin. J. Am. Soc. Nephrol. 2011;6:2599-604.
  15. Friberg L., Benson L., Lip G.Y. Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: the Swedish Atrial Fibrillation Cohort study. Eur. Heart J. 2014;36:297-306.
  16. Jun M., James M.T., Manns B.J., Quinn R.R., Ravani P., Tonelli M., Perkovic V., Winkelmayer W.C., Ma Z., Hemmelgarn B.R. The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. BMJ. 2015;350:246.
  17. Dahal K., Kunwar S., Rijal J., Schulman P., Lee J. Stroke, major bleeding and mortality outcomes in warfarin users with atrial fibrillation and chronic kidney disease: A meta-analysis of observational studies. Chest. 2016;149(4):951-9.
  18. Jun M., James M.T., Ma Z., Zhang J., Tonelli M., McAlister F.A., Manns B.J., Ravani P., Quinn R.R., Wiebe N., Perkovic V., Wilton S.B., Winkelmayer W.C., Hemmelgarn B.R. Alberta Kidney Disease Network. Warfarin initiation, atrial fibrillation, and kidney function: comparative effectiveness and safety of warfarin in older adults with newly diagnosed atrial fibrillation. Am. J. Kidney Dis. 2016. pii: S0272-6386(16)30627-8.
  19. Del-Carpio Munoz F., Gharacholou S.M., Munger T.M., Friedman P.A., Asirvatham S.J., Packer D.L., Noseworthy P.A. Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation. Am. J. Cardiol. 2016;117:69-75.
  20. Ando G., Capranzano P. Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with chronic kidney disease: A systematic review and network meta-analysis. Int. J. Cardiol. 2016; pii: S0167-5273(16)32808-X.
  21. Chronic kidney disease in adults: assessment and management. NICE Clinical guideline, 2014. nice.org.uk/guidance/cg182.
  22. Панченко Е.П. Новые пероральные антикоагулянты у больных неклапанной фибрилляцией предсердий и хронической болезнью почек. Атеротромбоз. 2015;2:51-7. [Panchenko Ye.P. New oral anticoagulants in patients with non-valve atrial fibrillation and chronic kidney disease. Atherothrombosis. 2015;2:51-7 (in Russ.)]
  23. Lip G.Y., Haguenoer K., Saint-Étienne C., Fauchier L. Relationship of the SAMe-TT(2)R(2) score to poor-quality anticoagulation, stroke, clinically relevant bleeding, and mortality in patients with atrial fibrillation. Chest. 2014;146:719-26.
  24. Gallego P., Roldan V., Marin F., Galvez J., Valdes M., Vicente V., Lip G.Y. SAMe-TT2R2 score, time in therapeutic range, and outcomes in anticoagulated patients with atrial fibrillation. Am. J. Med. 2014;127:1083-8.
  25. Marinigh R., Lane D.A., Lip G.Y. Severe renal impairment and stroke prevention in atrial fibrillation: implications for thromboprophylaxis and bleeding risk. J. Am. Coll. Cardiol. 2011;57:1339-48.
  26. Shah M., Avgil Tsadok M., Jackevicius C.A., Essebag V., Eisenberg M.J., Rahme E., Humphries K.H., Tu J.V., Behlouli H., Guo H., Pilote L. Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis. Circulation. 2014;129:1196-1203.
  27. Bonde A.N., Lip G.Y., Kamper A.L., Hansen P.R., Lamberts M., Hommel K., Hansen M.L., Gislason G.H., Torp-Pedersen C., Olesen J.B. Net clinical benefit of antithrombotic therapy in patients with atrial fibrillation and chronic kidney disease: a nationwide observational cohort study. J. Am. Coll. Cardiol. 2014;64:2471-82.
  28. Chan K.E., Edelman E.R., Wenger J.B., Thadhani R.I., Maddux F.W. Dabigatran and rivaroxaban use in atrial fibrillation patients on hemodialysis. Circulation. 2015;131:972-9.
  29. Keskar V., McArthur E., Wald R., Harel Z., Zimmerman D., Molnar A.O., Garg A.X., Lam N.N., McCallum M.K., Bota S.E., Perl J., Sood M.M. The association of anticoagulation, ischemic stroke, and hemorrhage in elderly adults with chronic kidney disease and atrial fibrillation. Kidney Int. 2016. pii: S0085-2538(16)30618-4.
  30. Roldan V., Marin F., Fernandez H., Manzano-Fernandez S., Gallego P., Valdes M., Vicente V., Lip G.Y. Renal impairment in a «real-life» cohort of anticoagulated patients with atrial fibrillation (implications for thromboembolism and bleeding). Am. J. Cardiol. 2013;111:1159-64.

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