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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
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[NOACs and Chronic kidney disease]
Luca Di Lullo1, Vincenzo Barbera1, Antonio Bellasi2
1U.O.C. Nefrologia e Dialisi, Ospedale L. Parodi Delfino, Colleferro, Rome, Italy.
Summary
Non-vitamin K-dependent oral anticoagulants (NOACs) show promise for atrial fibrillation (AF) patients with chronic kidney disease (CKD). This review examines NOACs in advanced CKD and dialysis patients, focusing on safety and efficacy.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients, increasing stroke risk.
- CKD patients, especially on renal replacement therapy (RRT), face higher bleeding risks.
- Warfarin use in CKD is limited by concerns and data scarcity, leading to underuse of anticoagulation.
Purpose of the Study:
- To review current data on non-vitamin K-dependent oral anticoagulants (NOACs) in advanced CKD.
- To assess NOACs' pharmacokinetic, observational, and prospective data in patients with creatinine clearance <25 ml/min and on dialysis.
Main Methods:
- Literature review of pharmacokinetic studies.
- Analysis of observational data.
- Evaluation of prospective trial data.
Main Results:
- NOACs reduce stroke, intracranial hemorrhage, and mortality in patients with normal renal function.
- Limited data exists for NOACs in patients with severe CKD (creatinine clearance <25 ml/min) and dialysis patients.
- Kidney function significantly impacts NOACs' elimination.
Conclusions:
- NOACs are recommended for AF patients at risk of stroke.
- Further research is crucial to establish NOACs' safety and efficacy in advanced CKD and RRT populations.
- Careful consideration of renal function is necessary when prescribing NOACs.
Keywords:
Atrial fibrillationNOACsanticoagulation therapychronic kidney diseasenonvitamin D oral anticoagulantswarfarinMore Related Videos
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