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Editorial
March 5, 2014

Warfarin Treatment in Patients With Atrial Fibrillation and Advanced Chronic Kidney DiseaseSins of Omission or Commission?

Author Affiliations
  • 1Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
  • 2Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, California
  • 3Associate Editor, JAMA
  • 4Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
  • 5Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA. 2014;311(9):913-915. doi:10.1001/jama.2014.1781

Both chronic kidney disease (CKD) and atrial fibrillation are increasingly common conditions. Recent estimates suggest that 6% to 8% of noninstitutionalized US adults have an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 (indicating CKD stage 3 or worse) and nearly 10% have albuminuria.1 Similarly, atrial fibrillation is estimated to have affected more than 2.7 million Americans in 2010.2 The prevalence and incidence of atrial fibrillation increases with the severity of CKD and, conversely, patients with atrial fibrillation are more likely to have CKD or develop progressive kidney dysfunction. It would therefore seem that aggressive treatment of atrial fibrillation, particularly with regard to oral anticoagulation for stroke prevention, would be paramount in patients with CKD.

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