Solna, Sweden—Use of DOACs over vitamin K antagonists (VKAs) has been increasing for years, primarily because of the lower risk of major bleeding and the reduced need for monitoring.

But what about other effects, including kidney outcomes?

The researchers from the Karolinska Institutet in Sweden and colleagues conducted a retrospective cohort study of Swedish patients with nonvalvular atrial fibrillation (AF). In an article published in the American Journal of Kidney Diseases, they reported that compared with VKAs, DOAC initiation was associated with a lower risk of the composite of kidney failure and sustained a 30% estimated glomerular filtration rate (eGFR) decline, as well as a lower risk of AKI occurrence.

As has been shown in previous trials, DOAC versus VKA treatment was associated with a lower risk of major bleeding, while having similar risks for the composite of stroke, systemic embolism, or death.

“Collectively, these findings recently published in the American Journal of Kidney Diseases (AJKD) add to emerging evidence on the safety and effectiveness of DOAC administered for atrial fibrillation,” the researchers wrote.

The study of nonvalvular AF patients was conducted in Stockholm, Sweden, from 2011 to 2018. The primary outcomes were defined as CKD progression (composite of >30% eGFR decline and kidney failure) and acute kidney injury (AKI; by diagnosis or KDIGO-defined transient creatinine elevations). Death, major bleeding, and the composite of stroke and systemic embolism were considered secondary outcomes for purposes of the study.

Of the 32,699 patients included and followed for a median of 3.8 years, 56% had started DOAC treatment and 44% had started VKA treatment. The participants’ median age was 75 years, with 45% women and 27% with eGFR <60 ml/min/1.73m2.

The study advised that the adjusted hazard ratio (HR) for DOAC versus VKA was 0.87 (95% CI, 0.78-0.98) for the risk of CKD progression and 0.88 (95% CI, 0.80-0.97) for AKI. For the other outcomes, HRs were 0.77 (95% CI, 0.67-0.89) for major bleeding, 0.93 (95% CI, 0.78-1.11) for the composite of stroke/systemic embolism, and 1.04 (95% CI, 0.95-1.14) for death.

“Among patients with nonvalvular AF treated in routine clinical practice, compared with VKA, DOAC use was associated with a lower risk of CKD progression, AKI, and major bleeding, but a similar risk of the composite of stroke/systemic embolism and death,” the researchers concluded.

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