Objective. To estimate the prevalence of chronic kidney disease (CKD) 3b – 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy.Materials and Methods. Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b – 5 st and newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected.Results. Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 – warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 – apixaban 10 mg / day (16.2 %).Conclusion. A quarter of patients with AF revealed a decreased GFR <45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml / min / 1.72 m2 were prescribed DOACs, 27 % – warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2.
Background Atrial fibrillation (AF) is a common comorbidity in around 10–15% of patients (pts) with CKD, while 30% of those with AF have CKD. In pts with advanced stages of CKD, safety and efficacy profiles of novel oral anticoagulants, in particular rivaroxaban, have been understudied. Purpose To evaluate safety and efficacy of rivaroxaban in pts with stage 4 CKD or a transient reduction in glomerular filtration rate (GFR) to 15–29 ml/min/1.73 m2. Materials and methods Data of 3,500 pts with nonvalvular AF in cardiovascular units for the period from 2017 to 2019 were analyzed. Of these, 507 (15%) showed a decrease in GFR to 29–15 ml/min/1.73 m2. 109 (3.1%) pts enrolled in the study (in accordance with inclusion criteria) and were randomized in a 2: 1 fashion to either the 15 mg rivaroxaban (n=74) or warfarin (n=36) group. The pts had either not previously been taking anticoagulants, or TTR was <65% in the case of taking warfarin. The average follow-up period was 18 months. Visits took place every 3 months, when compliance, haemoglobin were checked and GFR calculation was carried out. Primary endpoint: development of major and minor bleeding on the BARC scale. Secondary endpoints: thromboembolic events, cardiovascular mortality and all-cause mortality. Results The pts were of similar clinical and demographic profile. The median age was 77 years with 32 men in the rivaroxaban group and 14 in the warfarin group. The average CHA2DS2-VASc score was 4.6 and 4.7 (n/s) in the rivaroxaban and warfarin group, respectively, while the average HAS-BLED score was 3 (n/s) in both. Pts taking warfarin were significantly more likely to develop minor bleedings: 26 (72%) vs 27 (37%) in the rivaroxaban group, p=0.001. There were not detected significant differences in the ratio of major bleedings (warfarin 3 (8.3%) versus rivaroxaban 2 (2.7%) cases, p=0.3). No significant differences at secondary endpoints were observed. In the warfarin group, 1 (2.8%) ischemic stroke and 1 fatal haemorrhagic stroke occurred. In the rivaroxaban group, 1 (1.4%) ischemic stroke occurred during a 5-day break in taking the anticoagulant. 5 (6.9%) pts in the rivaroxaban group developed ACS, vs 1 (2.8%) in the warfarin group (n/s). 2 (2.7%) pts died from myocardial infarction in the rivaroxaban group and 1 (2.8%) - in the warfarin group (n/s). Mortality from all causes was 5 (6.6%) in the rivaroxaban group and 3 (8.3%) in the warfarin group (n/s). In the rivaroxaban group, GFR (CG formula) improved significantly more since the 3rd month of observation (in the 18th month of observation, the median value was 35.0 [29.0; 39.5] ml/min/1.73 m2 vs 27.0 [21.5; 31.5] ml/min/1.73 m2 in the warfarin group, p<0.001). Conclusion Significantly more pts within the warfarin group had minor bleedings. Pts during warfarin and rivaroxaban therapy showed an improvement in glomerular filtration, which was more pronounced in the rivaroxaban group. Funding Acknowledgement Type of funding source: None
Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15–29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15–29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р<0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p<0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.
Atrial fibrillation (AF) is the most frequent type of supraventricular arrhythmias. The anticoagulant therapy should be prescribed to prevent thromboembolic events. According to randomized clinical trials, anticoagulants do not always prove their high efficiency in the real clinical practice. It is a complicated issue for any doctor to prescribe the anticoagulant therapy for patients with AF and CKD. 30 % of patients with atrial fibrillation are known to have chronic kidney disease, while 10-15% of patients with chronic kidney disease are diagnosed with atrial fibrillation. Currently, there are scarce studies into the use of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease (in case of Glomerular Filtration Rate (GFR) below 45 ml/min/1.73 m2).Aim. To determine the dynamics of GFR in patients with AF and CKD (in case of GFR below 45 ml/min/1.73 m2).Material and Methods. The sub-analysis was carried out to examine a single-centre prospective study into the optimization of the anticoagulant therapy in the outpatient practice. Initially, 133 dabigatran taking patients were enrolled in the study, and 79 patients were included in the final analysis. Endpoints were changes in Glomerular Filtration Rate (CKD-EPI) formulae as of the inclusion date, in 6, 12, 24 and 60 months after the inclusion. Changes in the renal function shall mean a decrease or increase in GFR by ≥5 ml/min.Results. The average follow-up period for patients was 1785 ± 218 days. A GFR>45 ml/min/1.73 m2 occurred in 116 (87.2%) patients, and a GFR <45 ml/min/1.73 m2 was found in 17 (12.8%) patients. The average HAS-BLED score was 1.8, and CHA2DS2VASc score - 3.8. During the observation period, there were 3 cases of major bleeding and 133 cases of minor bleeding. Both major (р=0.025) and minor (р=0.012) bleeding were statistically significant more frequent in patients with GFR below 45 ml/min. During 5 years of follow-up, 66 (49.6%) patients had an average decrease in GFR of 3.32 ml/min/1.73 m2 per year. Patients with the initially declined GFR (below 45 ml/min) did not demonstrate a significant dynamic of the renal function during the dabigatran therapy. The mortality rate in this group during the observation period was 61.5%.Conclusion. In 49.6% of patients during 5 years of follow-up, GFR decreased by an average of 3.32 ml/min/1.73 m2 per year, which does not exceed the indicators typical for patients with cardiovascular events and CKD.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.