The Need to Evaluate Net Clinical Effect of Stroke Prevention Therapy in Patients with End Stage Renal Disease and Atrial Fibrillation
Chronic kidney disease (CKD) and atrial fibrillation (AF) are both emerging health epidemics worldwide. Atrial fibrillation is the most common heart rhythm disorder and the burden of this dysrhythmia is expected to increase as the population ages1. Similarly, chronic kidney disease is a disease of the elderly that is estimated to affect 40-50% of US adults over 65 in the near future2,3. This is likely due to manifestations of common risk factors and pathology that eventually lead to high cardiovascular and stroke risk in patients with CKD, especially patients with AF and CKD4,5. Unfortunately, the few observational studies that are available provide conflicting reports on the impact of therapies aimed at stroke prevention in patients with AF and CKD, leading some to question the incremental influence of AF on stroke risk6, and others to question if any anti-platelet or anticoagulation therapy reduces stroke risk in patients with AF7. The end result is significant uncertainty and variation in the management of patients with AF and CKD.
- Received December 6, 2015.
- Accepted December 14, 2015.