Chronic kidney disease (CKD) is prevalent in elderly patients with atrial fibrillation and is an
independent risk factor for stroke. Warfarin anticoagulation is efficacious for stroke
prevention in atrial fibrillation patients with moderate CKD (stage III, estimated glomerular
filtration rate 30-59 mL/min), but recent observational studies have challenged its value for
patients with end-stage renal disease requiring dialysis. The novel oral anticoagulants (ie,
dabigatran, apixaban, rivaroxaban) all undergo renal metabolism to varying degrees, and …

Background AF is the most common arrhythmia in patients with chronic kidney disease
(CKD) and is associated with increased risk of stroke and thromboembolism. The risk of
stroke increases as renal function declines. Conversely, patients with CKD, particularly
those on hemodialysis, are at an increased risk of bleeding. Oral anticoagulation is the most
effective form of thromboprophylaxis in patients with AF at increased risk of stroke. Concern
for bleeding has resulted in the underuse of anticoagulation in these patients.