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Kidney Injury in Anticoagulated Asians With Atrial Fibrillation
Study Questions:
What is the risk of acute kidney injury (AKI) associated with warfarin compared with dabigatran?
Methods:
This was a retrospective cohort study based on data obtained from the Taiwan National Health Insurance Registry Database. The study included 7,702 and 7,885 patients without prior kidney disease who were treated with dabigatran and warfarin, respectively, and 2,256 and 2,089 patients with chronic kidney disease (CKD) treated with dabigatran and warfarin, respectively. AKI was defined as an increase in serum creatinine of ≥0.3 mg/dl, a ≥50% increase in serum creatinine, or oliguria within 48 hours. The mean follow-up was approximately 8.5 months.
Results:
Among patients without CKD, the incidence of AKI was 2.17 and 3.47/100 person-years in the dabigatran and warfarin groups, respectively. Among patients with CKD, the incidence of AKI was 9.28 and 16.21/100 person-years in the dabigatran and warfarin groups, respectively. The incidence of AKI was significantly lower in the dabigatran group than in the warfarin group, both in patients with (hazard ratio [HR], 0.56) and without (HR, 0.62) CKD.
Conclusions:
Compared with warfarin, dabigatran is associated with approximately a 40% lower risk of AKI in atrial fibrillation (AF) patients with and without CKD.
Perspective:
It is likely that a lower risk of bleeding and thromboembolic events contributes to the lower incidence of AKI with dabigatran compared with warfarin. What is unclear is whether dabigatran has a net positive or negative effect on kidney injury compared with no anticoagulation in patients with AF.
Keywords: Acute Kidney Injury, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Creatinine, Oliguria, Primary Prevention, Renal Insufficiency, Chronic, Risk Assessment, Thromboembolism, Warfarin
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