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Published on: February 28, 2012
Influence of renal function on anticoagulation control in patients with non-valvular atrial fibrillation taking
José M Lobos-Bejarano1, Angel Castellanos Rodríguez2, Vivencio Barrios3
1Jazmin Primary Care Health Center, East Area Primary Care, Madrid, Spain.
Insights
Chronic kidney disease (CKD) significantly impairs anticoagulation control in non-valvular atrial fibrillation (AF) patients on warfarin. The SAMe-TT2R2 score is not predictive of poor anticoagulation in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Chronic kidney disease (CKD) is linked to poorer anticoagulation and increased bleeding risk.
- Optimal anticoagulation is crucial for non-valvular atrial fibrillation (AF) patients on vitamin K antagonists (VKA).
Purpose of the Study:
- To assess the association between impaired renal function (eGFR <60 mL/min/1.73 m² ) and anticoagulation control in non-valvular AF patients on VKA.
- To evaluate the predictive performance of the SAMe-TT2R2 score in patients with and without CKD.
Main Methods:
- Ancillary analysis of 1381 patients from the nationwide PAULA study.
- Retrospective, cross-sectional design evaluating renal function (eGFR) and anticoagulation control (TTR).
- Subgroup analysis of SAMe-TT2R2 score predictive value for TTR <65%.
Main Results:
- CKD (eGFR <60 mL/min/1.73 m²) was an independent predictor of poorer time in therapeutic range (TTR).
- The SAMe-TT2R2 score showed modest predictive value for TTR <65% in patients without CKD (AUC 0.558), but lacked predictive capacity in CKD patients (AUC 0.528).
- Factors associated with poorer TTR in preserved renal function subgroup included female sex, diet, polypharmacy, and amiodarone.
Conclusions:
- CKD is associated with suboptimal anticoagulation control in non-valvular AF patients treated with VKA.
- The SAMe-TT2R2 score is not a reliable predictor of poor anticoagulation control in CKD patients.
- Further research is needed to identify better predictors of anticoagulation control in CKD patients with AF.
Background And Purpose:
Chronic kidney disease (CKD) has been related to poor anticoagulation control and an increased risk of bleeding. This study aims to evaluate the association between impaired renal function (eGFR <60 mL/min/1.73 m2 ) and anticoagulation control in patients with non-valvular atrial fibrillation (AF) on vitamin K antagonists (VKA) therapy. We also assessed whether the predictive value of the SAMe-TT2 R2 score prevailed for subgroups both with and without CKD.
Methods:
This is an ancillary analysis of 1381 patients from the PAULA study, which was a cross-sectional, retrospective and nationwide multicenter study.
Results:
A total of 370 patients had eGFR <60 mL/min/1.73 m2 . Anticoagulation control levels progressively worsened across each stage of CKD. Multiple linear regression analysis showed CKD as an independent predictor of time in therapeutic range (TTR). In the subgroup of patients with preserved renal function, female sex, diet affecting INR, polypharmacy and amiodarone were associated with poorer TTR. The SAMe-TT2 R2 score had a significant but modest predictive value for TTR<65% (AUC, area under the curve 0.558, P = .002). In the subgroup of patients with CKD, the SAMe-TT2 R2 (>2 points) showed no significant predictive capacity for TTR (AUC 0.528, P = .354). The average TTR was similar for both sexes (P = .255), but with a higher percentage of males subjects with TTR ≥65% (P = .013).
Conclusion:
Chronic kidney disease is associated with poor anticoagulation control in patients with non-valvular AF taking VKA. The SAMe-TT2 R2 score was not predictive of poor TTR in the subgroup with CKD, although a modest predictive value for poor TTR was found in those without CKD.
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