disease interaction(s) of atrial fibrillation with chronic renal failure
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Introduction
Interactions:
- chronic renal failure increases risk of atrial fibrillation[1]
- among patients with atrial fibrillation, chronic renal failure is associated with higher risk for adverse cardiovascular events[2]
- chronic renal failure increases risk of thromboembolism in patients with atrial fibrillation[4]
- warfarin decreases risk for stroke or thromboembolism (RR = 0.76)[2]
- warfarin of no benefit in preventing thromboembolism when GFR < 15 mL/min/1.73 m2[4]
- aspirin associated with increased risk of bleeding (relative to no chronic renal failure)
- chronic renal failure increases risk of major hemorrhage in patients on warfarin (RR = 1.17)[2]; NNH = 7 patients for 1 year[3][4]
- patients with chronic renal failure require lower warfarin doses[3]
- patients with chronic renal failure are more likely to have INRs outside the therapeutic range[3]
- increased risk for major hemorrhage when INR >= 4 & GFR is < 45 mL/minute/1.73 m2[3]
- patients with chronic renal failure require lower warfarin doses[3]
- warfarin increases risk of ischemic stroke (RR=2.6), hemorrhage (RR=2.4) but decreases all-cause mortality (RR=0.8) relative to no anticoagulation (GFR < 50 mL/min/1.73 m2)[5]
- chronic renal failure increases risk of major hemorrhage in patients on aspirin (infrequently used for prevention of thromboembolism in patients with atrial fibrillation)
More general terms
References
- ↑ 1.0 1.1 Alonso A et al Chronic kidney disease is associated with the incidence of atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study. Circulation 2011 Jun 28; 123:2946 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21646496
- ↑ 2.0 2.1 2.2 2.3 Olesen JB et al Stroke and Bleeding in Atrial Fibrillation with Chronic Kidney Disease N Engl J Med 2012; 367:625-635August 16, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22894575 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1105594
- ↑ 3.0 3.1 3.2 3.3 3.4 Limdi NA et al. Influence of kidney function on risk of supratherapeutic international normalized ratio-related hemorrhage in warfarin users: A prospective cohort study. Am J Kidney Dis 2015 May; 65:701 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25468385
Jun M, James MT, Manns BJ et al The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. BMJ. 2015 Feb 3;350:h246 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25647223
Limdi NA, Beasley TM, Baird MF et al Kidney function influences warfarin responsiveness and hemorrhagic complications. J Am Soc Nephrol. 2009 Apr;20(4):912-21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19225037 - ↑ 4.0 4.1 4.2 4.3 Bonde AN et al. Renal function and the risk of stroke and bleeding in patients with atrial fibrillation: An observational cohort study. Stroke 2016 Nov; 47:2707. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27758943
- ↑ 5.0 5.1 Kumar S, de Lusignan S, McGovern A et al Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. BMJ 2018;360:k342 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29444881 <Internet> http://www.bmj.com/content/360/bmj.k342