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Renal Outcomes in Anticoagulated Patients With Atrial Fibrillation
Study Questions:
Does the type of anticoagulant in patients with atrial fibrillation (AF) affect renal outcomes?
Methods:
This was a retrospective database analysis of 9,769 patients (mean age 72.6 years) with AF who were treated with either warfarin or a nonvitamin K oral anticoagulant ([NOAC] dabigatran, rivaroxaban, or apixaban) and followed for a mean of 10.7 months. The renal outcomes that were tracked were: ≥30% decline in estimated glomerular filtration rate (eGFR), a doubling of the serum creatinine level, acute kidney injury (AKI), and kidney failure.
Results:
At 2 years, ≥30% decline in eGFR, doubling of the serum creatinine level, AKI, and kidney failure had occurred in 24.4%, 4%, 14.8%, and 1.7% of patients, respectively. When pooled, the three NOACs were associated with a significantly lower risk of a ≥30% decline in eGFR, doubling of the serum creatinine level, and AKI. The hazard ratios of the NOACs for these renal outcomes were 0.77, 0.62, and 0.68, respectively. When analyzed individually, dabigatran and rivaroxaban (but not apixaban) were associated with a significantly lower risk of the adverse renal outcomes.
Conclusions:
In patients with AF, dabigatran and rivaroxaban are associated with a significantly lower risk of adverse renal outcomes compared to warfarin.
Perspective:
This study demonstrates that a decline in renal function is fairly common in patients with AF who are anticoagulated. Gammacarboxyglutamic acid, which is vitamin K-dependent, inhibits renovascular calcification, and warfarin may promote a nephropathy by inhibiting the production of this protein matrix. In contrast, NOACs may attenuate renal disease by inhibiting factor Xa or thrombin, which have been associated with vascular inflammation.
Keywords: Acute Kidney Injury, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Creatinine, Factor Xa Inhibitors, Geriatrics, Glomerular Filtration Rate, Inflammation, Kidney Failure, Chronic, Secondary Prevention, Thrombin, Vitamin K, Warfarin
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