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Vitamin K antagonist use and renal function in pre-dialysis patients

Pauline Wm Voskamp1, Friedo W Dekker1, Maarten B Rookmaaker2

  • 1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.

Clinical Epidemiology
|June 9, 2018
PubMed
Abstract

Insights

Vitamin K antagonist use in pre-dialysis patients did not accelerate kidney function decline or hasten the start of dialysis. Further research is needed to understand potential confounding factors in vitamin K antagonist prescription.

Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Previous studies suggest vitamin K antagonists (VKAs) may accelerate renal function decline in patients with mild kidney impairment compared to direct oral anticoagulants.
  • The impact of VKAs on renal function in pre-dialysis patients remains unclear.

Purpose of the Study:

  • To investigate the association between vitamin K antagonist use and the rate of renal function decline.
  • To determine the time until the start of dialysis in incident pre-dialysis patients using vitamin K antagonists versus non-users.

Main Methods:

  • Analysis of 984 patients from the PREdialysis PAtient REcord study (1999-2011).
  • 101 patients used vitamin K antagonists.
  • Linear mixed models and Cox proportional hazards models were employed to assess renal function decline and time to dialysis initiation.

Main Results:

  • Vitamin K antagonist use was not significantly associated with accelerated kidney function decline (adjusted change: -0.09 mL/min/1.73 m²/year).
  • The adjusted hazard ratio for starting dialysis was 1.20 (95% CI 0.85 to 1.69) for vitamin K antagonist users compared to non-users, indicating no significant increase.

Conclusions:

  • In incident pre-dialysis patients, vitamin K antagonist use was not linked to faster kidney function decline or earlier dialysis initiation.
  • Confounding by indication may influence the observed lack of association, highlighting the need for further investigation into VKA prescribing patterns.
Keywords:
chronic kidney diseasecoumarinsepidemiologyglomerular filtration rate

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