Feedback

Medium-term and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation

Affiliation
Department of Medical and Surgical Sciences ,University Magna Græcia of Catanzaro ,Catanzaro ,Italy
Armentaro, Giuseppe;
Affiliation
Institute of Clinical Physiology (IFC-CNR) ,Section of Reggio Calabria ,Reggio Calabria ,Italy
D’Arrigo, Graziella;
Affiliation
Section of Geriatrics ,Department of Medical Sciences ,University of Turin ,Molinette Hospital ,Turin ,Italy
Bo, Mario;
Affiliation
Department of Medical and Surgical Sciences ,University Magna Græcia of Catanzaro ,Catanzaro ,Italy
Cassano, Velia;
Affiliation
Department of Medical and Surgical Sciences ,University Magna Græcia of Catanzaro ,Catanzaro ,Italy
Miceli, Sofia;
Affiliation
Institute of Clinical Physiology (IFC-CNR) ,Section of Rome ,Rome ,Italy
Pitino, Annalisa;
Affiliation
Institute of Clinical Physiology (IFC-CNR) ,Section of Reggio Calabria ,Reggio Calabria ,Italy
Tripepi, Giovanni;
Affiliation
Department of Advanced Biomedical Sciences ,University “Federico II” ,Naples ,Italy
Romeo, Santina Maria Grazia;
Affiliation
Department of Clinical and Molecular Medicine ,University Rome-Sapienza ,Rome ,Italy
Sesti, Giorgio;
Affiliation
Department of Clinical MedicineAalborg University ,Liverpool Centre for Cardiovascular Science ,University of Liverpool ,Liverpool John Moores University and Liverpool Heart and Chest Hospital ,Liverpool ,Denmark
Lip, Gregory Y. H.;
Affiliation
Department of Clinical Internal ,Anesthesiological and Cardiovascular Sciences ,Sapienza University of Rome ,Rome ,Italy
Pastori, Daniele;
Affiliation
Institute of Clinical Physiology (IFC-CNR) ,Section of Rome ,Rome ,Italy
Gori, Mercedes;
Affiliation
Department of Medical and Surgical Sciences ,University Magna Græcia of Catanzaro ,Catanzaro ,Italy
Sciacqua, Angela

Objective: Atrial Fibrillation (AF) and chronic kidney disease frequently coexist in the elderly. Warfarin-like drugs (WLDs) may be associated with a relatively greater decrease of estimated glomerular filtration rate (eGFR) as compared to direct oral anticoagulants (DOACs), but there is no evidence on the medium- and long-term changes. To further elucidate this issue in elderly patients with AF, we investigated the renal function deterioration in the two groups of the study (DOACs or WLDs). Patients and Methods: A total of 420 AF patients were enrolled (mean age: 77.0 ± 6.0 years; 136 on WLDs and 284 on DOACs). These patients underwent three eGFR measurements during the follow-up period. The between-arms difference of eGFR decline over time was investigated by Linear Mixed Models and group-based trajectory model analyses. Results: In the whole study cohort, after a median follow-up of 4.9 years (interquartile range: 2.7–7.0 years), eGFR decreased from 67.4 ± 18.2 to 47.1 ± 14.3 mL/min/1.73 m 2 ( p < 0.001). Remarkably, patients on DOACs experienced a significantly smaller eGFR decline than WLDs patients (−21.3% vs. −45.1%, p < 0.001) and this was true both in the medium-term (−6.6 vs. −19.9 mL/min/1.73 m 2 ) and in the long-term (−13.5 versus −34.2 mL/min/1.73 m 2 ) period. After stratification into five subgroups according to trajectories of renal function decline over time, logistic regression showed that DOACs patients had from 3.03 to 4.24-fold greater likelihood to belong to the trajectory with less marked eGFR decline over time than WLDs patients. Conclusion: Elderly patients with AF on treatment with DOACs had a relatively smaller decline of eGFR over time compared to those on treatment with WLDs. This is consistent with what was partly reported in the literature.

Cite

Citation style:
Could not load citation form.

Access Statistic

Total:
Downloads:
Abtractviews:
Last 12 Month:
Downloads:
Abtractviews:

Rights

License Holder: Copyright © 2023 Armentaro, D’Arrigo, Bo, Cassano, Miceli, Pitino, Tripepi, Romeo, Sesti, Lip, Pastori, Gori and Sciacqua.

Use and reproduction: