NONVALVULAR ATRIAL FIBRILLATION AND DIABETIC NEPHROPATHY: EPIDEMIOLOGY, PROGNOSIS, AND CHOICE OF ANTICOAGULANT THERAPY.

In this review we present data on prevalence of atrial fibrillation (AF) among patients with type 2 diabetes (T2D), diabetic nephropathy and chronic kidney disease (CKD). Patients with nonvalvular AF and T2D combined with CKD have elevated risk of both bleeding and thromboembolic complications, as well as of all cause death. Efficacy and safety of novel oral anticoagulants (NOAC) depend on comorbidities and can be determined by the presence of T2D and/or diabetic nephropathy. Use of warfarin in CKD in some cases provides no preventive effect relative to risk of stroke and is characterized by increased risk of bleeding because of poor INR control, and possibly development of calcification of arteries. Presence of diabetic nephropathy requires monitoring of renal filtration function for correction of doses or selection of another anticoagulant. Lack of data from randomized controlled trials hampers choice of anticoagulant therapy in patients with terminal CKD on hemodialysis or after renal transplantation.