The Danish authors of an observational study published in the Clinical Kidney Journal called for more clinical awareness to prevent kidney complications among patients who initiate oral anticoagulants (OACs).
The researchers sought to answer the question of whether the use of DOACs, which is recommended as first-line treatment of atrial fibrillation, is associated with lower risks of kidney complications compared with VKAs. The association was examined in a nationwide, population-based cohort study in Denmark from 2012 to 2018.
The cohort study included 32,781 patients initiating OAC treatment within 3 months after an atrial fibrillation diagnosis; 77% started taking DOACs. The study team used routinely collected creatinine measurements from laboratory databases to follow patients in an intention-to-treat approach for AKI and CKD progression.
The participants’ median age was 75 years, with 25% having a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2. The median follow-up was 2.3 (interquartile range 1.1-3.9) years.
The results indicated that the weighted 1-year risks of AKI were 13.6% in DOAC users and 15.0% in VKA users (hazard ratio [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), the researchers added, noting that results were similar across subgroups and in the per-protocol analysis.
“Initiation of DOACs was associated with a decreased risk of AKI and CKD progression compared with VKAs,” the authors wrote. “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.”
Specifically, the researchers suggested, “Our findings underscore the need for routinely monitoring of creatinine and efforts to prevent and treat kidney injury among patients with atrial fibrillation treated with oral anticoagulant drugs.”
Background information in the study advised that OAC treatment has been associated with kidney injury. “Unexplained acute kidney injury (AKI) in an OAC-treated patient has been labeled ‘anticoagulant-related nephropathy’ and linked to specific histopathologic findings including glomerular hemorrhage and tubular injury,” the authors wrote. “The phenomenon has most often been described in patients with VKA-induced coagulopathy—a population with observed AKI prevalences between 19% and 63% at the time of over anticoagulation.”
That is especially significant because the use of OACs is so widespread, according to the researchers. “Oral anticoagulants (OACs) are widely used to prevent blood clots in patients with atrial fibrillation (AF),” the study pointed out. “For more than half a century, vitamin K antagonists (VKAs) were the only option for long-term oral anticoagulation, but in the last decade, direct oral anticoagulants (DOACs) have been introduced. DOACs have advantages such as fixed dosing with no monitoring requirements, fewer pharmacological interactions, and a substantially lower risk of intracranial bleeding. Accordingly, there has been a shift from VKA to DOAC in clinical practice, and DOACs are now preferred over VKAs for newly diagnosed AF patients.”
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