n. 23, January 2019

 
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Survey on the management of atrial fibrillation in patients with chronic kidney disease and end-stage renal disease

Dear Colleague,

 

As you are probably aware, atrial fibrillation and chronic kidney disease share common risk factors and both are increasingly prevalent worldwide. Both conditions are strongly linked with an increased risk of stroke and cardiovascular mortality. Atrial fibrillation and chronic kidney disease have a close bidirectional relationship and often co-exist: approximately 20% of patients with chronic kidney disease have symptomatic atrial fibrillation and roughly 50% of patients with atrial fibrillation will have some degree of renal impairment. Patients with both conditions have a higher risk of stroke and mortality compared with patients who only have either atrial fibrillation or stroke.

 

Oral anticoagulant therapy using vitamin K antagonists (most commonly warfarin) or non-vitamin K antagonists (apixaban, dabigatran, edoxaban and rivaroxaban) is the cornerstone of stroke prevention in patients with atrial fibrillation with at least one further risk factor for stroke. However, the risk of bleeding increases with the severity of chronic kidney disease.

 

The presence of chronic kidney disease in patients with atrial fibrillation can be associated with challenging decision-making regarding specific therapies or interventions, as the risk benefit ratio may be substantially altered, especially in patients with end-stage renal disease. Since patients with advanced chronic kidney disease have commonly been excluded from randomised clinical trials there is little high-quality evidence to inform the management of patients with chronic kidney disease and atrial fibrillation in daily clinical practice.

 

This survey has been jointly designed by the European Renal and Cardiovascular medicine (EURECA-m) working group of the European Renal Association/European Dialysis and Transplantation Association together with the Scientific Initiatives Committee of the European Heart Rhythm Association. It has been sent to all ERA-ETDA members as well as members of the European Heart Rhythm Association (EHRA).

 

The purpose of this survey is to assess the common “real world” practice in the management of patients with both atrial fibrillation (excluding those with prosthetic mechanical heart valves or mitral stenosis) and chronic kidney disease in European Renal and Cardiology Units.

 

Completion of the survey requires less than 10 minutes of your time. The results of the survey will be used to inform future research initiatives to be conducted across Europe to tackle the difficult issue that is the management of atrial fibrillation in patients with chronic kidney disease.

 

Click here to complete the survey

 

Best regards

Francesca Mallamaci, EURECA-m Chair

Charles Ferro, EURECA-m Vice Chair

 

 

 

 
 
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