EHRA Presents First ESC Recommendations for CKD and Cardiac Arrythmias

EHRA Presents First ESC Recommendations for CKD and Cardiac Arrythmias

A European Heart Rhythm Association (EHRA) paper detailing the first ESC recommendations for patients diagnosed with cardiac arrhythmias and chronic kidney disease (CKD) was presented last month at the EHRA EUROPACE – CARDIOSTIM 2015 and published in EP Europace. EHRA is a registered subsidiary of the European Society of Cardiology (ESC), backed by the US and Asia Pacific Heart Rhythm Society (HRS).

Chair of EHRA’s writing group, Professor Giuseppe Boriani said: “CKD occurs in more than 10% of adults and has a major impact on treatment decisions in patients with arrhythmias. Choice of antiarrhythmic strategy, drugs and specifically anticoagulants, and whether or not to implant a cardiac device should take impairment in renal function into account.”

“There is increasing awareness in the cardiology community that renal impairment influences how we treat patients with arrhythmias,” added Professor Boriani. “The introduction of non-vitamin K oral anticoagulants (also called new oral anticoagulants or NOACs) as an alternative to warfarin brought this issue to the fore since renal function determines whether or not they can be prescribed. The ESC decided it was a good time to introduce recommendations.”

The cardiovascular and renal systems perform in direct relationship to each other, with even the mildest deficiencies in one system causing the other to be at risk for disease. In fact, sudden cardiac deaths account for as much as half of deaths among dialysis patients, pediatric patients included.

The EHRA recommendation was formulated by a group of nephrologists and arrhythmia-specialized cardiologists based all over the globe. It discusses the following points:

  • How to stage and monitor CKD
  • The association between CKD and hypertension, heart failure and atrial fibrillation
  • How CKD affects management of patients with arrhythmias or cardiac devices
  • Risk of stroke and bleeding in patients with atrial fibrillation and CKD
  • How arrhythmias and cardiac devices affect management of CKD.

These salient points also highlighted the usefulness and reliability of estimated glomerular filtration rate (eGFR) compared to serum creatinine in staging CKD, and the importance of monitoring renal function in all patients with known cardiac disease or altered heart rhythm.

Further, physicians were called on to be more mindful of prescriptions given to these patients and tailor dosages according to their kidney’s ability to eliminate the drugs, such as in the case of prescribing NOACs over warfarin. Professor Boriani said: “Patients with atrial fibrillation and CKD have a greater risk of both thromboembolism and major bleeding which makes decision making particularly challenging in this setting.”

“Increasing specialisation in internal medicine is a positive evolution overall but there is a need for more communication between cardiologists and nephrologists to improve the care of very complex patients,” explained Professor Boriani. “The association between kidney disease and cardiovascular disease is growing as the population ages, leading to higher costs and a greater imperative to manage patients together.”

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