دورية أكاديمية
أعرض في EDS

Oral anticoagulant treatment and risk of kidney disease-a nationwide, population-based cohort study.

التفاصيل البيبلوغرافية
العنوان: Oral anticoagulant treatment and risk of kidney disease-a nationwide, population-based cohort study.
المؤلفون: Vestergaard AEF; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Jensen SK; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Heide-Jørgensen U; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Adelborg K; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Biochemistry, Gødstrup Regional Hospital, Gødstrup, Denmark., Birn H; Departments of Biomedicine and Clinical Medicine, Aarhus University, Aarhus, Denmark.; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark., Carrero JJ; Department of Medical Epidemiology and Biostatisctics, Karolinska Institutet, Stockholm, Sweden., Christiansen CF; Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
المصدر: Clinical kidney journal [Clin Kidney J] 2023 Oct 03; Vol. 17 (1), pp. sfad252. Date of Electronic Publication: 2023 Oct 03 (Print Publication: 2024).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 101579321 Publication Model: eCollection Cited Medium: Print ISSN: 2048-8505 (Print) Linking ISSN: 20488505 NLM ISO Abbreviation: Clin Kidney J Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Oxford : Oxford University Press
مستخلص: Background: Direct oral anticoagulants (DOACs) are recommended as first-line treatment of atrial fibrillation. Whether DOAC use is associated with lower risks of kidney complications compared with vitamin K antagonists (VKAs) remains unclear. We examined this association in a nationwide, population-based cohort study.
Methods: We conducted a cohort study including patients initiating oral anticoagulant treatment within 3 months after an atrial fibrillation diagnosis in Denmark during 2012-18. Using routinely collected creatinine measurements from laboratory databases, we followed patients in an intention-to-treat approach for acute kidney injury (AKI) and chronic kidney disease (CKD) progression. We used propensity-score weighting to balance baseline confounders, computed weighted risks and weighted hazard ratios (HRs) with 95% confidence intervals (CIs) comparing DOACs with VKAs. We performed several subgroup analyses and a per-protocol analysis.
Results: We included 32 781 persons with atrial fibrillation initiating oral anticoagulation (77% initiating DOACs). The median age was 75 years, 25% had a baseline estimated glomerular filtration rate <60 mL/min/1.73 m 2 , and median follow-up was 2.3 (interquartile range 1.1-3.9) years. The weighted 1-year risks of AKI were 13.6% in DOAC users and 15.0% in VKA users (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). Results were similar across subgroups and in the per-protocol analysis.
Conclusions: Initiation of DOACs was associated with a decreased risk of AKI and CKD progression compared with VKAs. 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.
Competing Interests: The Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, is involved in studies with funding from various companies as research grants to (and administered by) Aarhus University. None of these studies is related to the current study. J.-J.C. acknowledges consultancy for AstraZeneca and Baxter, and grant support to Karolinska Institutet from AstraZeneca, Viforpharma and Astellas, all outside the submitted work. H.B. acknowledges research grant or contracts (paid to institution) from Vifor Pharma and GSK; consulting and/or advisory board fees from AstraZeneca, Vifor Pharma, Boehringer Ingelheim and GSK; payment or honoraria for manuscripts, lectures, presentations or chair at meetings from AstraZeneca, Alexion, NOVO, Netdoktor.dk; support for meetings and/or travel from AstraZeneca, expert testimony/working groups within the Danish Society of Nephrology and Danish Board of Health; and chair of the Danish Society of Nephrology. K.A. was employed at Aarhus University Hospital during the preparation of this work, but is now an employee of Novo Nordisk A/S.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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فهرسة مساهمة: Keywords: acute kidney injury; anticoagulant drugs; atrial fibrillation; pharmacoepidemiology; renal insufficiency
تواريخ الأحداث: Date Created: 20240108 Latest Revision: 20240109
رمز التحديث: 20240109
مُعرف محوري في PubMed: PMC10768770
DOI: 10.1093/ckj/sfad252
PMID: 38186872
قاعدة البيانات: MEDLINE
الوصف
تدمد:2048-8505
DOI:10.1093/ckj/sfad252