Is New Always Better? Apixaban vs. Warfarin and CKD Progression

Atrial fibrillation (AF) is the most common arrhythmia in patients with chronic kidney disease (CKD), with a prevalence of nearly 24.5%.  This is over 2 times higher than that of the general adult population aged 65 and older. In fact, those with advanced CKD (stage IV-V) have a prevalence of atrial fibrillation that is 7% higher  when compared to those with GFR > 60 ml/min. This demonstrates that there is a stepwise increase in risk for AF associated with advancing CKD. This increased risk is rooted in three main mechanisms: structural remodeling, inflammatory changes and sympathetic hyperactivation. The pathophysiology of CKD contributes to the increased risk of developing atrial fibrillation. Specifically, overactivation of the renin-angiotensin-aldosterone system induces apoptosis and reactive interstitial fibrosis of cardiac myocytes via angiotensin II. This contributes to structural remodeling of the heart, which increases the risk for atrial fibrillation. Another potential mechanism is the elevation of inflammatory markers, which lead to decreased cytokine clearance and reduced antioxidant levels. In fact, the REGARDS study showed a statistically significant relationship between elevated C reactive protein level, AF risk, and patients in CKD stage III-IV.  In addition to producing these risk factors for atrial fibrillation, CKD contributes to thrombus … Continue reading Is New Always Better? Apixaban vs. Warfarin and CKD Progression