Recommendations for CKD/Kidney Failure

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
1	B-R	1. For patients with AF at elevated risk for stroke and CKD stage 3, treatment with warfarin or, preferably, evidence-based doses of direct thrombin or factor Xa inhibitors (Table 19) is recommended to reduce the risk of stroke.1–3
2a	B-NR	2. For patients with AF at elevated risk for stroke and CKD stage 4, treatment with warfarin or labeled doses of DOACs is reasonable to reduce the risk of stroke.4,5
2b	B-NR	3. For patients with AF at elevated risk for stroke and who have end-stage CKD (CrCl <15 mL/min) or are on dialysis, it might be reasonable to prescribe warfarin (INR 2.0–3.0) or an evidence-based dose of apixaban for oral anticoagulation to reduce the risk of stroke.6,7