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Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease

AIMS: To describe the use of warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), to evaluate changes in renal function over time and predictors of rapid decline, and to describe time in therapeutic range (TTR) and predictors of...

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Autores principales: Batra, Gorav, Modica, Angelo, Renlund, Henrik, Larsson, Anders, Christersson, Christina, Held, Claes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9476150/
https://www.ncbi.nlm.nih.gov/pubmed/36104096
http://dx.doi.org/10.1136/openhrt-2022-002043
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author Batra, Gorav
Modica, Angelo
Renlund, Henrik
Larsson, Anders
Christersson, Christina
Held, Claes
author_facet Batra, Gorav
Modica, Angelo
Renlund, Henrik
Larsson, Anders
Christersson, Christina
Held, Claes
author_sort Batra, Gorav
collection PubMed
description AIMS: To describe the use of warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), to evaluate changes in renal function over time and predictors of rapid decline, and to describe time in therapeutic range (TTR) and predictors of poor TTR among patients on warfarin. METHODS AND RESULTS: Using data from AuriculA, the Swedish oral anticoagulation registry, patients with AF on warfarin or DOAC were identified between 2013 and 2018 (N=6567). Estimated glomerular filtration rate (eGFR) was calculated and categorised into normal (≥90 mL/min/1.73 m(2)), mild CKD (60–89 mL/min/1.73 m(2)), moderate CKD (30–59 mL/min/1.73 m(2)), severe CKD (15–29 mL/min/1.73 m(2)) and end-stage CKD (<15 mL/min/1.73 m(2))/dialysis. TTR was estimated using international normalised ratio (INR) measurements. Predictors of eGFR decline over time and of poor TTR were estimated using regression analysis. Between 2013 and 2018, use of DOAC increased from 9.2% to 89.3%, with a corresponding decline in warfarin. A similar trend was observed in patients with mild to moderate CKD, while DOAC over warfarin increased slower among patients with severe to end-stage CKD/dialysis. In patients treated with warfarin, the median TTR was 77.1%. Worse TTR was observed among patients with severe CKD (70.0%) and end-stage CKD/dialysis (67.5%). A gradual annual decline in eGFR was observed (−1.1 mL/min/1.73 m(2)), with a more rapid decline among patients with older age, female sex, diabetes mellitus and/or heart failure. CONCLUSION: In patients with AF, use of DOAC has steadily increased across different CKD stages, but not in patients with severe to end-stage CKD/dialysis despite these patients having poor INR control. Patients with AF have a gradual decline in renal function, with a more rapid decline among a subgroup of patients.
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spelling pubmed-94761502022-09-16 Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease Batra, Gorav Modica, Angelo Renlund, Henrik Larsson, Anders Christersson, Christina Held, Claes Open Heart Arrhythmias and Sudden Death AIMS: To describe the use of warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), to evaluate changes in renal function over time and predictors of rapid decline, and to describe time in therapeutic range (TTR) and predictors of poor TTR among patients on warfarin. METHODS AND RESULTS: Using data from AuriculA, the Swedish oral anticoagulation registry, patients with AF on warfarin or DOAC were identified between 2013 and 2018 (N=6567). Estimated glomerular filtration rate (eGFR) was calculated and categorised into normal (≥90 mL/min/1.73 m(2)), mild CKD (60–89 mL/min/1.73 m(2)), moderate CKD (30–59 mL/min/1.73 m(2)), severe CKD (15–29 mL/min/1.73 m(2)) and end-stage CKD (<15 mL/min/1.73 m(2))/dialysis. TTR was estimated using international normalised ratio (INR) measurements. Predictors of eGFR decline over time and of poor TTR were estimated using regression analysis. Between 2013 and 2018, use of DOAC increased from 9.2% to 89.3%, with a corresponding decline in warfarin. A similar trend was observed in patients with mild to moderate CKD, while DOAC over warfarin increased slower among patients with severe to end-stage CKD/dialysis. In patients treated with warfarin, the median TTR was 77.1%. Worse TTR was observed among patients with severe CKD (70.0%) and end-stage CKD/dialysis (67.5%). A gradual annual decline in eGFR was observed (−1.1 mL/min/1.73 m(2)), with a more rapid decline among patients with older age, female sex, diabetes mellitus and/or heart failure. CONCLUSION: In patients with AF, use of DOAC has steadily increased across different CKD stages, but not in patients with severe to end-stage CKD/dialysis despite these patients having poor INR control. Patients with AF have a gradual decline in renal function, with a more rapid decline among a subgroup of patients. BMJ Publishing Group 2022-09-14 /pmc/articles/PMC9476150/ /pubmed/36104096 http://dx.doi.org/10.1136/openhrt-2022-002043 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Arrhythmias and Sudden Death
Batra, Gorav
Modica, Angelo
Renlund, Henrik
Larsson, Anders
Christersson, Christina
Held, Claes
Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
title Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
title_full Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
title_fullStr Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
title_full_unstemmed Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
title_short Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
title_sort oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
topic Arrhythmias and Sudden Death
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9476150/
https://www.ncbi.nlm.nih.gov/pubmed/36104096
http://dx.doi.org/10.1136/openhrt-2022-002043
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