Anticoagulation in Atrial Fibrillation and Chronic Kidney Disease: A Critical Review and Future Perspectives in Peritoneal Dialysis

Abstract

Atrial fibrillation (AF) and chronic kidney disease (CKD) are two closely related pathophysiologically interconnected conditions, sharing common risk factors and resulting in poor clinical outcomes when coexisting. In patients with end-stage renal disease (ESRD) on renal replacement therapy, AF significantly complicates clinical management, as these patients have a doubled risk of death, stroke, and bleeding. Choosing the optimal anticoagulant strategy remains a major challenge, with direct oral anticoagulants (DOACs) emerging as a potentially superior alternative to vitamin K antagonists (VKAs), especially due to their renoprotective profile. However, data in patients on peritoneal dialysis (PD) remain sparse, constituting a significant gap in the scientific literature. This review examines the current state of evidence on anticoagulation in patients with AF and advanced CKD, with a particular focus on new therapeutic perspectives in the PD population.