NEW STUDY data has shown that using direct oral anticoagulants (DOAC) for the treatment of atrial fibrillation could reduce the risk of chronic kidney disease (CKD) progression and acute kidney injury (AKI) compared with vitamin K antagonists.
This research was presented at the American Society of Nephrology Kidney Week conference 2022, held in Orlando, Florida, USA. The team, led by Ane Emilie Friis Vestergaard, Aarhus Universitet Klinisk Epidemiologisk Afdeling, Midtjylland, Denmark, conducted a user-active comparative cohort study of 33,670 individuals with a mean age of 75 years, who had been commenced on anticoagulant treatment for atrial fibrillation, with the aim of evaluating whether DOAC use conferred a reduce risk of renal complications compared to vitamin K antagonists.
One-quarter of the candidates had an estimated glomerular filtration rate (eGFR) of <60 mL/Min/1.73m2, 52% were of male sex, 77% were initiated on a DOAC, and the average follow-up time was 2.3 years. Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to define AKI, and CKD was defined as a composite of >30% reduction in eGFR or renal failure.
The analysis revealed that the cumulative risk for AKI within the first year of treatment was greater in the vitamin K antagonist group at 15.5% compared with 13.9% in the DOAC group. Furthermore, they found that the 5-year CKD progression risk was also higher in the vitamin K antagonist group at 15.4% compared with 14.0% in the DOAC group. Hazard ratios highlighted that those treated with DOACs had a 15% lower AKI risk and 16% lower CKD progression risk than those treated with vitamin K antagonists. The team evaluated the findings across different subgroups, including age, baseline eGFR, diabetes, and sex, where they found similar results.
This study highlights that AKI and CKD progression do not occur infrequently in patients treated with anticoagulants for atrial fibrillation, but that the risk is lower when using DOACs compared to vitamin K antagonists. A limitation to consider is that this study was conducted in a Danish population, and therefore future work could assess anticoagulants and renal complications in other populations.