Chronic kidney disease and atrial fibrillation: approaches to the choice of antiarrhythmic therapy

In clinical practice, impaired renal function is often combined with cardiovascular diseases, in particular with atrial fibrillation. As you know, the kidneys perform many functions, including excretory, metabolic and endocrine. The cardiorenal axis is regulated in such a way that an imbalance results in both cardiac and renal remodeling. Therefore, the pathophysiological relationships between the kidneys and the heart are of great clinical importance. Considering the need to create the basis for personalized patient-oriented care, documents on the position of a number of associations and societies dedicated to the treatment of patients with atrial fibrillation and chronic kidney disease are currently presented. Treatment of atrial fibrillation includes prophylactic anticoagulation and pharmacological therapy aimed at maintaining sinus rhythm or correcting the frequency of ventricular responses. At the same time, when choosing the optimal dose of oral direct anticoagulant drugs, there are a number of discrepancies in published regulatory documents of various cardiological and nephrological communities. It should be noted that in recent years there has been no significant improvement in the clinical pharmacology of arrhythmias. Existing pharmacological approaches for the correction of arrhythmias in patients with atrial fibrillation and chronic kidney disease are limited by their limited effectiveness and the possibility of developing dangerous effects, including the proarrhythmic effect against ventricular arrhythmias and organ-toxic complications. The use of catheter and surgical ablation is inhibited by the complexity, cost and high relapse rate in patients with chronic kidney disease. It seems that antiarrhythmic drugs are not given enough attention compared to anticoagulant therapy, especially in patients with atrial fibrillation and chronic kidney disease. This review article discusses approaches to the choice of antiarrhythmic therapy in this category of patients.