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Oral anticoagulant treatment and risk of kidney disease-a nationwide, population-based cohort study.
Vestergaard, Ane Emilie Friis; Jensen, Simon Kok; Heide-Jørgensen, Uffe; Adelborg, Kasper; Birn, Henrik; Carrero, Juan-Jesus; Christiansen, Christian Fynbo.
Afiliación
  • Vestergaard AEF; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
  • Jensen SK; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
  • Heide-Jørgensen U; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
  • Adelborg K; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
  • Birn H; Department of Clinical Biochemistry, Gødstrup Regional Hospital, Gødstrup, Denmark.
  • Carrero JJ; Departments of Biomedicine and Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Christiansen CF; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Clin Kidney J ; 17(1): sfad252, 2024 Jan.
Article en En | MEDLINE | ID: mdl-38186872
ABSTRACT

Background:

Direct oral anticoagulants (DOACs) are recommended as first-line treatment of atrial fibrillation. Whether DOAC use is associated with lower risks of kidney complications compared with vitamin K antagonists (VKAs) remains unclear. We examined this association in a nationwide, population-based cohort study.

Methods:

We conducted a cohort study including patients initiating oral anticoagulant treatment within 3 months after an atrial fibrillation diagnosis in Denmark during 2012-18. Using routinely collected creatinine measurements from laboratory databases, we followed patients in an intention-to-treat approach for acute kidney injury (AKI) and chronic kidney disease (CKD) progression. We used propensity-score weighting to balance baseline confounders, computed weighted risks and weighted hazard ratios (HRs) with 95% confidence intervals (CIs) comparing DOACs with VKAs. We performed several subgroup analyses and a per-protocol analysis.

Results:

We included 32 781 persons with atrial fibrillation initiating oral anticoagulation (77% initiating DOACs). The median age was 75 years, 25% had a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2, and median follow-up was 2.3 (interquartile range 1.1-3.9) years. The weighted 1-year risks of AKI were 13.6% in DOAC users and 15.0% in VKA users (HR 0.86, 95% CI 0.82; 0.91). The weighted 5-year risks of CKD progression were 13.9% in DOAC users and 15.4% in VKA users (HR 0.85, 95% CI 0.79; 0.92). Results were similar across subgroups and in the per-protocol analysis.

Conclusions:

Initiation of DOACs was associated with a decreased risk of AKI and CKD progression compared with VKAs. Despite the potential limitations of observational studies, our findings support the need for increased clinical awareness to prevent kidney complications among patients who initiate oral anticoagulants.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Idioma: En Revista: Clin Kidney J Año: 2024 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Idioma: En Revista: Clin Kidney J Año: 2024 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido