Anticoagulation for atrial fibrillation in adults with advanced kidney disease: UK kidney association clinical practice guideline
Year: 2026
Type: article
Abstract: Patients with chronic kidney disease (CKD) have an increased risk of developing atrial fibrillation (AF). CKD is also associated with an increased risk of stroke and systemic embolism (SSE). Despite the increased thromboembolic risk associated with CKD and AF, patients with advanced CKD simultaneously have a higher risk of bleeding. Following results from large randomised controlled trials prophylaxis of thromboembolic events from atrial fibrillation (AF) has shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs). However, trials of DOACs excluded patients with advanced kidney disease (CrCl < 30 ml/min), therefore good-quality data are limited in this population. This leads to decision-making around anticoagulation difficult. In those with advanced kidney disease, especially those on dialysis, there is limited data on the efficacy of anticoagulants for AF in terms of stroke reduction. There are ongoing studies to determine efficacy of anticoagulants in reducing the risk of thromboembolic stroke and systemic embolism in this population. These UK Kidney Association (UKKA) guidelines, which have been endorsed by the British Cardiovascular Society, provide best-practice guidance on the use of anticoagulants for atrial fibrillation in the context of advanced CKD. There are recommendations about the option of no anticoagulation, the use of DOACs, the monitoring of anticoagulants and the use of left atrial appendage occlusion. It also includes research recommendations.
Source: BMC Nephrology
Authors: Kathrine Parker, Albert Power, Richard Buka, Mark Davies, Maria A. Gauci, Alan Hancock, John Hartemink, Anneka Mitchell, Honey Thomas, Jung Yin Tsang, Isaac Tseng, Andrew Turley, Gregory Y. H. Lip, on behalf of the guideline authors, Yvonne Bernes, Kate Bramham, Satarupa Choudhuri, Lauren Hall, Nicola Korn, Penny Lewis, Lara Roberts, Huw Rowswell, Hannah Stacey, Katherine Stirling, Jecko Thachil, Fang Feng Ting
Institutions: University of Manchester, Manchester University NHS Foundation Trust, North Bristol NHS Trust, University of Bristol, Sandwell & West Birmingham Hospitals NHS Trust, University of Birmingham, Cardiff and Vale University Health Board, Mater Dei Hospital, University Hospitals Plymouth NHS Trust, Northumbria Healthcare NHS Foundation Trust, Churchill Hospital, University College London, South Tees Hospitals NHS Foundation Trust, University of Liverpool, Aalborg University, Sheffield Teaching Hospitals NHS Foundation Trust, St Thomas' Hospital, King's College London, Northern Care Alliance NHS Foundation Trust, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, King's College Hospital NHS Foundation Trust, Watford General Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7203662940