Anticoagulation for atrial fibrillation in adults with advanced kidney disease: UK kidney association clinical practice guideline

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.

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Publication Details

Journal
BMC Nephrology
Published
2026-08-19
DOI
https://doi.org/10.1186/s12882-026-05270-9
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
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article

Anticoagulation for atrial fibrillation in adults with advanced kidney disease: UK kidney association clinical practice guideline

Chen I. Tseng, Satarupa Choudhuri, Dr Hannah Stacey, Kate Bramham et al.
BMC Nephrology
Atrial Fibrillation Management and Outcomes
article

Anticoagulation for atrial fibrillation in adults with advanced kidney disease: UK kidney association clinical practice guideline

Chen I. Tseng, Satarupa Choudhuri, Dr Hannah Stacey, Kate Bramham, John Hartemink, Anneka Mitchell, Gregory Y.H. Lip, Fang Feng Ting, Kathrine Parker, Nicola Korn, Jung Yin Tsang, Maria Angela Gauci, Jecko Thachil, P.J. Lewis, Honey Thomas, Katherine Stirling, Albert Power, Lauren Hall, Richard; id_orcid 0000-0002-2738-6236 Buka, Andrew Turley, Lara Roberts, Huw Rowswell, Mark Davies, Yvonne Bernes, Alan Hancock, on behalf of the guideline authors
article en

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.

BMC Nephrology
Cardiff and Vale University Health Board (GB), North Bristol NHS Trust (GB), St Thomas' Hospital (GB), University of Liverpool (GB), Leeds Teaching Hospitals NHS Trust (GB), Sandwell & West Birmingham Hospitals NHS Trust (GB), Norfolk and Norwich University Hospitals NHS Foundation Trust (GB), South Essex Partnership University Foundation NHS Trust (GB), Northumbria Healthcare NHS Foundation Trust (GB), Churchill Hospital (GB), Mater Dei Hospital (MT), Watford General Hospital (GB), Leeds and York Partnership NHS Foundation Trust (GB), University of Manchester (GB), South Tees Hospitals NHS Foundation Trust (GB), Northern Health and Social Care Trust (GB), University of Bristol (GB), Manchester University NHS Foundation Trust (GB), Sheffield Teaching Hospitals NHS Foundation Trust (GB), Centre on Dynamics of Ethnicity (GB), King's College Hospital NHS Foundation Trust (GB), Mid Essex Hospital Services NHS Trust (GB), University Hospitals Plymouth NHS Trust (GB), University College London (GB), University of Birmingham (GB), Aalborg University (DK)
Good health and well-being
Openalex Percentile: Top 10%
Atrial Fibrillation Management and Outcomes
DOIOpen Access PDFOpenAlex
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