Kidney disease progression risk lower with DOACs vs. vitamin K antagonists in AF
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Among adults with nonvalvular atrial fibrillation, direct oral anticoagulant initiation was associated with lower risk for renal failure or progression of chronic kidney disease compared with vitamin K antagonist initiation, data show.
“Concerns about the possibility of direct oral anticoagulant (DOAC)-related nephropathy may limit its use,” Juan-Jesus Carrero, Pharm, PhD, professor of cardiorenal epidemiology at the Karolinska Institutet in Stockholm, told Healio. “In this cohort study of patients with nonvalvular AF from routine clinical practice, initiation of DOAC vs. a vitamin K antagonist was associated with more favorable kidney outcomes, ie, a lower risk for the composite of kidney failure and sustained 30% estimated glomerular filtration rate (eGFR) decline, as well as a lower risk for acute kidney injury occurrence. In agreement with trial evidence, we also showed that DOAC vs. vitamin K antagonist treatment was associated with a lower risk for major bleeding but a similar risk for the composite of stroke, systemic embolism or death.”
In a retrospective study, Carrero and colleagues analyzed data from 32,699 patients with nonvalvular AF living in Stockholm from 2011 to 2018 who newly initiated DOAC or vitamin K antagonist (warfarin) treatment, followed for a median of 3.8 years. The median age of patients was 75 years, 45% were women and 27% had an eGFR of less than 60 mL/min/1.73 m2. Primary outcomes were chronic kidney disease (CKD) progression, defined as a composite of at least a 30% decline in eGFR and renal failure, and acute kidney injury. Secondary outcomes were death, major bleeding and a composite of stroke and systemic embolism.
The findings were published in the American Journal of Kidney Diseases.
Within the cohort, 56% initiated DOACs.
Compared with vitamin K antagonist initiation, the adjusted HR for DOAC initiation was 0.87 (95% CI, 0.78-0.98) for CKD progression risk and 0.88 (95% CI, 0.8-0.97) for acute kidney injury risk.
For secondary outcomes, HRs were 0.77 (95% CI, 0.67-0.89) for major bleeding, 0.93 (95% CI, 0.78-1.11) for the composite of stroke and systemic embolism and 1.04 (95% CI, 0.95-1.14) for death. Results persisted in analyses stratified by age, sex and baseline eGFR, and in analyses restricted to those at high risk for thromboembolic events.
“These findings add to emerging evidence on the safety and effectiveness of DOACs administered for atrial fibrillation,” Carrero told Healio. “We now need clinical trials to expand the efficacy and safety of DOACs to people with AF on dialysis, a patient group currently left without treatment options.”
For more information:
Juan-Jesus Carrero, Pharm, PhD, can be reached at juan.jesus.carrero@ki.se; Twitter: @jjcarrero1.
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