Renal Outcomes in Anticoagulated Patients With Atrial Fibrillation

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Oral anticoagulation is crucial for stroke prevention in atrial fibrillation (AF).
• Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used, with emerging data suggesting potential renal benefits over warfarin.
• Renal outcomes are a significant concern in patients requiring long-term anticoagulation.

Purpose of the Study:

• To compare the renal effects of four oral anticoagulants: apixaban, dabigatran, rivaroxaban, and warfarin.
• To evaluate the incidence of major renal outcomes including eGFR decline, serum creatinine doubling, acute kidney injury (AKI), and kidney failure.
• To assess the comparative safety profiles of NOACs versus warfarin regarding kidney function in nonvalvular AF patients.

Main Methods:

• Utilized a large U.S. administrative database linked with laboratory results.
• Included 9,769 patients with nonvalvular AF initiating oral anticoagulants between 2010 and 2016.
• Employed inverse probability of treatment weighting and Cox proportional hazards regression for comparative analysis.

Main Results:

• Over two years, cumulative risks were: 24.4% for ≥30% eGFR decline, 4.0% for creatinine doubling, 14.8% for AKI, and 1.7% for kidney failure.
• Pooled NOACs demonstrated significantly lower risks of eGFR decline (HR 0.77), creatinine doubling (HR 0.62), and AKI (HR 0.68) compared to warfarin.
• Dabigatran and rivaroxaban showed reduced risks for specific renal outcomes versus warfarin; apixaban did not show statistically significant differences.

Conclusions:

• Renal function decline is a frequent complication in anticoagulated AF patients.
• NOACs, particularly dabigatran and rivaroxaban, appear to be associated with a lower risk of adverse renal outcomes compared to warfarin.
• These findings suggest NOACs may offer a renal protective advantage in AF management.