Prediction of The Risk of Thromboembolic Complications in Patients with Atrial Fibrillation and Chronic Kidney Disease

The risk of acute cerebrovascular accident and other systemic thromboembolic complications is very high in both atrial fibrillation and chronic kidney disease. However, it is currently unknown to what extent the prognostic value of these risks increases when these two conditions coexist.These risk factors lead to a sharp increase in disability and mortality, posing serious challenges to the healthcare system. The aim of the study is the early prediction of the risk of thromboembolic complications in patients with atrial fibrillation and chronic kidney disease. The study included 64 patients with atrial fibrillation and stage III CKD, divided into two subgroups based on anticoagulant therapy (warfarin or rivaroxaban). Anticoagulant doses were adjusted individually. The CHA2DS2-VASc score was used to assess the risk of thromboembolic complications. Patients were re-examined dynamically at months 3, 6, 9, and 12 of the study. Plasma creatinine levels in the warfarin group averaged 139.7±27.9 μmol/L at baseline, rising to 160.2±32.7 μmol/L (p<0.001) by month 12 of the study. In this group of patients, creatinine levels increased by an average of 20.6 μmol/L. In contrast, positive dynamics in renal filtration function were observed in the rivaroxaban group. Blood creatinine levels were 133.1±23.9 μmol/L at baseline and 139.3±25.1 μmol/L at month 12 of observation (p<0.05). Quarterly monitoring of blood creatinine in patients with AF and stage III CKD receiving rivaroxaban demonstrated an increase of an average of 6.2 μmol/L (p<0.001). Accordingly, a feasibility study analysis was also conducted in each subgroup, where 20.7% of cases were noted in the warfarin group (p<0.001) and 8.6% of cases in the rivaroxaban group. A high frequency of feasibility study was recorded in the group with CKD and AF (OR-2.1, 95% CI 0.60-7.36). In patients with AF and CKD treated with warfarin, TECs occurred in 20.7% of cases, which is significantly lower than in patients taking NOACs (8.6%, p<0.001). The study also identified a negative impact of warfarin on renal filtration function.