Prescribing anticholinergic drugs to patients with atrial fibrillation and stage 4 chronic kidney disease in real-world clinical practice
Shikh E.V., Eremina S.S., Ebzeeva E.Yu., Piksina G.F., Orlova N.V., Ostroumova O.D.
Background: Atrial fibrillation (AF) is the most common heart rhythm disorder in the elderly. The combination of AF and chronic kidney disease (CKD), especially against the background of a decreased glomerular filtration rate, creates significant difficulties in choosing optimal pharmacotherapy. Numerous studies demonstrate cognitive decline in patients with AF and CKD, particularly when prescribing drugs with anticholinergic burden (ACB).
Objective: To analyze drug prescriptions in hospitalized patients over 65 years of age with AF and stage 4 CKD from the perspective of anticholinergic burden (ACB) level.
Material and methods: The study included 86 patients divided into 2 groups: group 1 – 27 patients (median age 87 [82;89] years, women – 81,5%) hospitalized in 2018–2019, group 2 – 59 patients (median age 91 [87;93] years, women – 78%) treated in 2022–2023 at the same multidisciplinary hospital in the same departments. The ACB level was assessed using the Anticholinergic Cognitive Burden (ACB) Scale.
Results: In the first group, 14,8% of patients had an ACB score of 1, while in the second group, this proportion was 32,2%. Patients with a total ACB score of 2 were statistically significantly more common in group 1 compared to group 2 (44,4% vs. 11,9%, respectively, p=0,002). The most frequently prescribed drugs with ACB were metoprolol, furosemide, isosorbide dinitrate, digoxin, and prednisolone. Both isolated prescriptions of these drugs and their combinations were identified.
Conclusion: In polymorphic patients, drug prescription should be carried out with extreme caution, especially concerning medications with anticholinergic burden. Appropriate prescription of these drugs should be considered as a method of preventing adverse outcomes in this category of patients.
For citations: Shikh E.V., Eremina S.S., Ebzeeva E.Yu., Piksina G.F., Orlova N.V., Ostroumova O.D. Prescribing anticholinergic drugs to patients with atrial fibrillation and stage 4 chronic kidney disease in real-world clinical practice. Pharmateca. 2026;33(4):19-27. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.4.19-27
Authors’ contribution: E.V. Shikh – development of the research idea, goal setting, determination of the research design and methodology, scientific editing, approval of the final version of the article. S.S. Eremina - conducting research, collecting data, creating a database, statistical processing of results and their interpretation, preparing the text of the article, analyzing the literature. E.Yu. Ebzeeva – conducting the research, interpreting the research results, preparing the text of the article, scientific editing, approval of the final version of the article. G.F. Piksina – scientific editing, approval of the final version of the article.
N.V. Orlova – scientific editing, approval of the final version of the article. O.D. Ostroumova – development of the research idea, goal setting, determination of the research design and methodology, scientific editing, approval of the final version of the article. All authors read and approved the final version of the manuscript.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Patient Consent for Publication: The retrospective design of the study did not require informed consent from patients for statistical processing of anonymized data for subsequent publication.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
Keywords
atrial fibrillation
chronic kidney disease
adverse drug reactions
anticholinergic burden
old age
About the Authors
Evgeniya V. Shikh, Dr. Sci. (Med.), Professor, Corr. Member of the Russian Academy of Sciences, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine at the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; chih@mail.ru, ORCID: https://orcid.org/0000-0001-6589-7654, eLibrary SPIN: 2397-8414Sofya S. Eremina, Postgraduate Student of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine at the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; sofya.eremina@mail.ru, ORCID: https://orcid.org/0000-0001-7989-354X, eLibrary SPIN: 5630-4333
Elizaveta Iu. Ebzeeva, Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Therapy and Polymorbid Pathology named after Academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; veta-veta67@mail.ru,
ORCID: https://orcid.org/0000-0001-6573-4169
Galina F. Piksina, Cand. Sci. (Med.), Cardiologist, acting deputy chief physician for emergency care, Municipal Clinical Hospital №15 named after O.M. Filatov, Moscow, Russia; galina-piksina@yandex.ru, ORCID: https://orcid.org/0000-0003-2114-1227
Natalya V. Orlova, Dr. Sci. (Med.), Professor, Professor of the Department of Faculty Therapy at the Institute of Medical Sciences, Pirogov Russian National Research Medical University, Moscow, Russia; vrach315@yandex.ru, ORCID: https://orcid.org/0000-0002-4293-3285
Olga D. Ostroumova, Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology named after Academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education; Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ostroumova.olga@mail.ru,
ORCID: https://orcid.org/0000-0002-0795-8225, eLibrary SPIN: 3910-6585 (corresponding author)
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