Chapter 14 Stroke and Atrial Fibrillation in Chronic Kidney Disease and Dialysis

Chronic kidney disease affects an estimated 500million individuals globally, and strokes are up to 10-fold more common in patients with chronic kidney disease than in age-matched patients without chronic kidney disease. The importance of stroke in patients with chronic kidney disease is underscored by high rates of poststroke disability and death. The high incidence of stroke is attributed to a combination of highly prevalent traditional risk factors for stroke including older age and hypertension as well as chronic kidney disease–specific risk factors including vascular calcification and dialysis. Nonvalvular atrial fibrillation is of particular interest as a risk factor for ischemic stroke because it occurs frequently, but oral anticoagulation to prevent strokes (in patients with nonvalvular atrial fibrillation and chronic kidney disease) is controversial because of the lack of high-quality data resulting in unclear efficacy and potentially higher risks of bleeding.