The Impairment in Kidney Function in the Oral Anticoagulation Era. A Pathophysiological Insight

Scicchitano, Pietro; Tucci, Marco; Bellino, Maria Consiglia; Cortese, Francesca; Cecere, Annagrazia; Palo, Micaela De; Massari, Francesco; Caldarola, Pasquale; Silvestris, Franco; Ciccone, Marco Matteo

doi:10.1007/s10557-020-07004-x

Cited by 17 publications

(9 citation statements)

References 97 publications

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“…Appropriate anticoagulant therapy and frequent renal function monitoring are crucial in these patients [37]. Moreover, taking into account concomitant increased risk of bleeding in patients with CKD and reported kidney injury in patients on warfarin during excessive anticoagulation non-vitamin K oral anticoagulants (unless contraindicated), especially apixaban, could be preferred over vitamin K antagonists [38][39][40][41][42]. Left atrial appendage occlusion might be an option in patients with severe CKD who have contraindications to lifelong anticoagulant therapy [43].…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease and Its Impact on a Prothrombotic State in Patients with Atrial Fibrillation

Matusik

Heleniak

Papuga-Szela

et al. 2020

JCM

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It is unclear whether chronic kidney disease (CKD) increases thromboembolism in atrial fibrillation (AF). We conducted a retrospective cross-sectional analysis of 502 non-anticoagulated AF patients (median age, 66 (60–73) years, median CHA2DS2-VASc score, 3.0 (2.0–4.0)) with an estimated glomerular filtration rate (eGFR) ≥ 15 mL/min/1.73 m2. Endogenous thrombin potential (ETP), clot permeability (Ks), and clot lysis time (CLT), among others, were determined. Patients with stage 4 CKD (n = 87; 17.3%) had higher ETP and prolonged CLT compared with those with stage 3 CKD. In patients with stages 3 to 4 CKD (n = 180; 35.9%) N-terminal pro-B-type natriuretic peptide predicted low Ks (the lowest quartile, odds ratio [OR] per 100 pg/mL: 1.03, 95% confidence interval [CI]: 1.01–1.06) and prolonged CLT (the top quartile, OR per 100 pg/mL: 1.05, 95% CI: 1.02–1.08), but not high ETP. In the whole cohort, after adjustment for CHA2DS2-VASc score, stage 4 CKD, but not stage 3 CKD, predicted high ETP (OR: 9.06; 95% CI: 4.44−18.46) and prolonged CLT (OR: 3.58; 95% CI: 1.76–7.28), but not low Ks. compared to the reference eGFR category. This study is the first to demonstrate the prothrombotic and antifibrinolytic alterations in AF patients with stage 4 CKD, but not stage 3 CKD irrespective of clinical stroke risk factors.

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Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease and Its Impact on a Prothrombotic State in Patients with Atrial Fibrillation

Matusik

Heleniak

Papuga-Szela

et al. 2020

JCM

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“…For example, atrial fibrillation and KI are bidirectional. Thus, an anticoagulant may protect against KI but may also lead to acute KI and chronic worsening of the kidney 17 . This means our results may include KI caused by atrial fibrillation or other underlying diseases.…”

Section: Discussionmentioning

confidence: 91%

“…Thus, an anticoagulant may protect against KI but may also lead to acute KI and chronic worsening of the kidney. 17 This means our results may include KI caused by atrial fibrillation or other underlying diseases. Third, the definition of ARN remains to be clarified.…”

Section: What This Study Addsmentioning

confidence: 97%

Differences in risk factors for anticoagulant‐related nephropathy between warfarin and direct oral anticoagulants: Analysis of the Japanese adverse drug event report database

Mitsuboshi

Niimura

Zamami

et al. 2020

Brit J Clinical Pharma

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Limited information is available on anticoagulant‐related nephropathy (ARN). We therefore reviewed the Japanese Adverse Drug Event Report database to investigate kidney injury (KI) in patients administered warfarin or direct oral anticoagulants (DOACs) and sought to clarify the risk factors for ARN. KI risk in warfarin users was associated with male sex (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.35–2.13; P < .01) and age ≥80 years (OR, 1.35; 95% CI, 1.07–1.72; P = .01). KI risk in DOAC users was associated with body weight ≥80 kg (OR, 1.60; 95% CI, 1.01–2.53; P = .04) and use of dabigatran (OR, 1.61; 95% CI, 1.09–2.37; P < .01). Our findings suggest that risk factors for ARN differ between warfarin and DOACs and that these risk factors may be associated with bleeding risk. Therefore, the risk of ARN may be decreased by better managing bleeding risk in patients taking anticoagulants.

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“…However, Korea is a developed country and their quality control in laboratories is reliable. Fifth, the important confounding factors, the history of cardiovascular diseases, such as heart failure, atrial fibrillation, and acute coronary syndrome ( 50 – 52 ), were only based on the CCI. The NHIS cohort consisted of the results of health examination and the administrative code (i.e., ICD-10) that was claimed during real practice.…”

Section: Discussionmentioning

confidence: 99%

Transiently Observed Trace Albuminuria on Urine Dipstick Test Is Associated With All-Cause Death, Cardiovascular Death, and Incident Chronic Kidney Disease: A National Health Insurance Service-National Sample Cohort in Korea

Park

Woo

Leem

et al. 2022

Front. Cardiovasc. Med.

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IntroductionAlbuminuria is a well-known risk factor for end-stage kidney disease, all-cause mortality, and cardiovascular mortality, even when the albumin-to-creatinine ratio is <30 mg/g. However, the association between transiently observed trace albuminuria and these major adverse outcomes has not yet been reported. This study aimed to examine the effect of transient albuminuria on these major adverse outcomes using the National Health Insurance Service data in Korea.Methods and ResultsThe National Health Insurance Service-National Sample Cohort from Korea, followed from 2002 to 2015, consisted of 1,025,340 individuals, accounting for 2.2% of the total Korean population. We analyzed the effect of transient albuminuria on all-cause death, cardiovascular death, and incident chronic kidney disease (CKD) and compared it with the group without albuminuria. Among 1,025,340 individuals, 121,876 and 2,815 had transient albuminuria and no albuminuria, respectively. Adjusted hazard ratios of the transient albuminuria group for cardiovascular death and incident CKD were 1.76 (1.01–3.08) and 1.28 (1.15–1.43), respectively. There were significant differences in all-cause death, cardiovascular death, and incident CKD between the two groups after propensity score matching (p = 0.0037, p = 0.015, and p < 0.0001, respectively). Propensity score matching with bootstrapping showed that the hazard ratios of the transient albuminuria group for all-cause death and cardiovascular death were 1.39 (1.01–1.92) and 2.18 (1.08–5.98), respectively.ConclusionsIn this nationwide, large-scale, retrospective cohort study, transient albuminuria was associated with all-cause death, cardiovascular death, and incident CKD, suggesting that transient albuminuria could be a risk marker for adverse outcomes in the future, and that its own subclinical phenotype could play an important role during the course of CKD.

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The Impairment in Kidney Function in the Oral Anticoagulation Era. A Pathophysiological Insight

Cited by 17 publications

References 97 publications

Chronic Kidney Disease and Its Impact on a Prothrombotic State in Patients with Atrial Fibrillation

Chronic Kidney Disease and Its Impact on a Prothrombotic State in Patients with Atrial Fibrillation

Differences in risk factors for anticoagulant‐related nephropathy between warfarin and direct oral anticoagulants: Analysis of the Japanese adverse drug event report database

Transiently Observed Trace Albuminuria on Urine Dipstick Test Is Associated With All-Cause Death, Cardiovascular Death, and Incident Chronic Kidney Disease: A National Health Insurance Service-National Sample Cohort in Korea

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