Anticoagulation for Atrial Fibrillation in Advanced CKD: Can Observational Studies Provide the Answer?

Atrial fibrillation is the most common arrhythmia in people with chronic kidney disease (CKD). Based on US Renal Data System data, 24% of Medicare beneficiaries with CKD have a diagnosis of nonvalvular atrial fibrillation, as compared to 10% of the non-CKD population, with higher prevalence among older individuals and those with more advanced CKD.1 Atrial fibrillation is consequential among people with CKD: 2-year age-adjusted survival for individuals with atrial fibrillation and CKD stage 4-5 non-dialysis is only 60%, compared to 83% in the non-CKD population.