Treatment of Chronic Kidney Disease with Atrial Fibrillation (CKD G1–G4)
When chronic kidney disease at GFR categories G1–G4 (eGFR ≥15 ml/min per 1.73 m²) is accompanied by atrial fibrillation, thromboprophylaxis decisions require careful attention to both stroke risk and the patient’s level of kidney function.
Clinical scenario: CKD G1–G4 (eGFR ≥15 ml/min per 1.73 m²) with concurrent atrial fibrillation — a combination where the choice of anticoagulant agent and its appropriateness for the patient’s GFR stage both matter.
Approach: Evidence supports preferring a specific class of oral anticoagulant agents over traditional vitamin K antagonist therapy for thromboprophylaxis in this population. Kidney function is a key factor in how the approach is applied.
Full protocol details — including how GFR stage shapes the regimen — are available below.
References
DOI: 10.1016/j.kint.2023.10.018
We recommend use of non–vitamin K antagonist oral anticoagulants (NOACs) in preference to vitamin K antagonists (e.g., warfarin) for thromboprophylaxis in atrial fibrillation in people with CKD G1–G4 (1C).
NOAC dose adjustment for GFR is required, with caution needed at CKD G4–G5.
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