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C ardiovascular disease is common in advanced chronic kidney disease (CKD) and endstage renal disease. In fact, cardiovascular disease accounts for approximately 50% of deaths among dialysis patients with the most common etiology being arrhythmia or cardiac arrest (40% of deaths). Atrial fibrillation is an exceedingly common arrhythmia among patients with CKD, and in particular those with end-stage renal disease on dialysis in whom more than 10% have atrial fibrillation, a prevalence more than 10-fold higher than the general population. The presence of atrial fibrillation in advanced CKD is associated with progression to end-stage renal disease, cardiovascular events, and death. Management of atrial fibrillation with anticoagulation in this population is complicated by both a decreased efficacy with regard to stroke prevention and a markedly increased risk for bleeding complications. Given the high burden of

Predialysis Care and Cardiovascular Outcomes: Why the Lead Up to Dialysis Matters