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

Frontiers in Pharmacology

Pharmacology

Santina Maria Grazia Romeo¹  Daniele Pastori²  Gregory Y. H. Lip³  Giorgio Sesti⁴  Angela Sciacqua⁵  Giuseppe Armentaro⁵  Velia Cassano⁵  Sofia Miceli⁵  Graziella D’Arrigo⁶  Giovanni Tripepi⁶  Mercedes Gori⁷  Annalisa Pitino⁷  Mario Bo⁸ 

[1] Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy;Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy;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;Department of Clinical and Molecular Medicine, University Rome-Sapienza, Rome, Italy;Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy;Institute of Clinical Physiology (IFC-CNR), Section of Reggio Calabria, Reggio Calabria, Italy;Institute of Clinical Physiology (IFC-CNR), Section of Rome, Rome, Italy;Section of Geriatrics, Department of Medical Sciences, University of Turin, Molinette Hospital, Turin, Italy;

关键词: atrial fibrillation;    chronic kidney disease;    elderly;    DOACs;    warfarin-like drugs;    EGFR decline;   

DOI  :  10.3389/fphar.2023.1210560

 received in 2023-04-22, accepted in 2023-06-21,  发布年份 2023

来源: Frontiers

【 摘 要 】

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 m2 (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 m2) and in the long-term (−13.5 versus −34.2 mL/min/1.73 m2) 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.

【 授权许可】

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