Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.
Nephrol Dial Transplant. 2018 Oct 1;33(10):1683-1689. doi: 10.1093/ndt/gfx322.
Atrial fibrillation (AF) is the most frequent arrhythmia in common clinical practice and its prevalence is markedly increased among patients with chronic kidney disease (CKD). The presence of CKD increases the incidence of AF and vice versa. Both AF and CKD increase the risk of stroke or systemic thromboembolism and oral anticoagulation is the mainstay for thromboembolic event prevention in patients with AF. Novel oral anticoagulants (NOACs) are nowadays often used in patients with AF and CKD, but they display a variable degree of renal elimination and the risk of accumulation and bleeding increases among patients with CKD in particular as kidney disease progresses. While recent data have demonstrated that patients with Stage 3 CKD benefit even more from oral anticoagulation therapies in comparison with patients with normal renal function, relatively little is known about the best choice of anticoagulation in patients with advanced and, in particular, end-stage renal disease, as these patients were excluded from all pivotal Phase 3 NOACs trials. This review summarizes current knowledge on the efficacy and safety of these agents in individuals with CKD and provides CKD stage-specific recommendations.
心房颤动（AF）是常见临床实践中最常见的心律失常，其在慢性肾脏病（CKD）患者中的发病率明显增加。CKD 的存在会增加 AF 的发病率，反之亦然。AF 和 CKD 都会增加中风或全身性血栓栓塞的风险，口服抗凝剂是 AF 患者预防血栓栓塞事件的主要方法。新型口服抗凝剂（NOACs）目前常用于 AF 和 CKD 患者，但它们的肾脏清除率存在差异，特别是随着肾脏疾病的进展，CKD 患者的药物蓄积和出血风险增加。虽然最近的数据表明，与肾功能正常的患者相比，处于 3 期 CKD 的患者从口服抗凝治疗中获益更多，但对于晚期和特别是终末期肾病患者的最佳抗凝选择，人们知之甚少，因为这些患者被所有关键的 3 期 NOAC 试验排除在外。这篇综述总结了这些药物在 CKD 患者中的疗效和安全性的现有知识，并提供了基于 CKD 分期的建议。
