Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal AssociationAug 20, 2026

Risk scores for kidney disease, irregular heartbeat, and stroke with new diabetes and heart drugs and high other death risks

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Aug 21, 2026

Abstract

Atrial fibrillation and chronic kidney disease often coexist, increasing the risk of severe health outcomes.

Atrial fibrillation and chronic kidney disease share common risk factors and can lead to serious complications such as stroke and heart failure.
Current risk scores like CHA₂DS₂-VASc and HAS-BLED may not fully consider the impact of advanced chronic kidney disease on thromboembolic and bleeding risks.
Higher CHA₂DS₂-VASc scores could suggest a greater risk of competing mortality not accounted for in existing models.
Recent advancements in treatment options have changed cardiorenal outcomes, which challenges the accuracy of historical risk score calibrations.
There is a need for more dynamic, kidney-focused risk stratification to better assess thromboembolic and hemorrhagic risks in patients with both atrial fibrillation and chronic kidney disease.

Simplified

Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, share risk factors and pathophysiology, and confer a high burden of stroke, bleeding, heart failure, and premature death. Risk scores such as CHA₂DS₂-VASc, which estimates thromboembolic risk, and HAS-BLED, which estimates bleeding risk, were derived in populations including relatively few patients with advanced CKD. Consequently, they may not adequately account for CKD-specific modifiers of thromboembolic and hemorrhagic risk. Although these scores do not formally incorporate competing non-stroke mortality, higher CHA₂DS₂-VASc scores may indirectly identify patients with a greater competing risk of death. Meanwhile, widespread use of renin-angiotensin-aldosterone system blockade, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide‑1 receptor agonists has reshaped cardiorenal prognosis, further challenging historical calibrations of stroke and bleeding scores. In this perspective, we critically appraise conventional risk scores in AF with CKD, highlight their limitations in the context of modern preventive therapies and competing mortality, and outline priorities for more dynamic, kidney‑focused risk stratification.

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Risk scores for kidney disease, irregular heartbeat, and stroke with new diabetes and heart drugs and high other death risks

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