engleski

A new oral anticoagulant therapy in patients with nondialysis chronic kidney disease and atrial fibrillation

Chronic kidney disease (CKD) has not been included in common stroke risk stratification schemes like the CHA2DS2VASc score, but is important predictor of thromboembolism and raises the risk of systemic thromboembolism in patients (p) with atrial fibrillation (AF). Atrial fibrillation is the most commom arrhythmia in population. Untreated are more prone to thrombosis. When treated with vitamin K-antagonists like warfarin, pt are more prone to bleeding and may have a worsening of renal function because vitamin K- dependet factors protect against vascular and renovascular calcification. The aim of this study was to investigate effects of new oral anticoagulants (NOACs) on renal function parameters in non dialysis (NDCKD) patients with estimated glomerular filtration rate (eGFR) >30 mlmin-11.73m2. A total of 25 NDCKDp with normal, mildly or moderate decreased (estimated GFR > 30 mlmin-11.73m2) renal function were included (Group A) and followed for 12 months (age 67±7 years, 13M/12F, body mass index (BMI) 33.4±5.1 kg/m2, duration of hypertension 10±5 years, duration of AF 3±2 years, eGFR 59±23 mlmin-11.73m2 (was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula). Dabigatran was started as 150 mg twice daily dose and rivaroksaban 20 mg once daily in patients with eGFR ≥ 50 mlmin-11.73m2. In p with eGFR <50 and > 30 mlmin-11.73m2 dabigatran was started as 110 twice daily dose and rivaroksaban 15 mg once daily. During the same period from January 1, 2015. through December 31, 2015 (Group B) were 220 p on warfarine for non valvular AF: age 64-95 (71±15 years), body mass index (BMI) 36.4±5.1 kg/m2, duration of hypertension 13±5 years, duration of AF 5±4 years, eGFR 55±21 mlmin- 11.73m2. HAS-BLED score was 2, 6 and 2.9 and mean CHA2DS2VASc score was of 2.8 and 3.1. Bleeding or worsening of renal function were categorized as adverse event (AE). Changes in eGFR for up to12 months were evaluated. Treatment with warfarin caused a significant eGFR declined from 55±21 mlmin-11.73m2 to 52±19 (p<0.001), and 30% (66 of 220) p have AE (30%). Patients with poor international normalized ratio control (time in therapeutic range or TTR<65% have 70% p) have a faster decline in eGFR. However, the 12-month administration of NOACs caused a nonsignificant decrease in eGFR. In p on dabigatran and rivaroksaban in both doses eGFR (from 59±23 mlmin- 11.73m2 to 58±19 mlmin-11.73m2 (p=0.01)) did not significantly changed, with less AE (12%, 3 pt with mildy gastrointestinal bleeding). The results of our study suggest that therapy with NOACs have a better bleeding risk profile and less decline in eGFR compared with warfarin.

NOACs; renal function

nije evidentirano