Changes in Renal Function in Patients With Atrial Fibrillation An Analysis From the RE-LY Trial

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:65

Article

Boehm, Michael¹  Ezekowitz, Michael D.^2,3,4  Connolly, Stuart J.⁵  Eikelboom, John W.⁵  Hohnloser, Stefan H.⁶  Reilly, Paul A.⁷  Schumacher, Helmut⁸  Brueckmann, Martina^8,9  Schirmer, Stephan H.¹  Kratz, Mario T.¹  Yusuf, Salim⁵  Diener, Hans-Christoph¹⁰  Hijazi, Ziad^11,12  Wallentin, Lars^11,12 

[1] Univ Klinikum Saarlandes, Innere Med Klin 3, D-66421 Homburg, Germany

[2] Jefferson Univ, Sidney Kimmel Med Coll, Philadelphia, PA USA

[3] Lankenau Inst Med Res, Wynnewood, PA USA

[4] Ctr Heart, Wynnewood, PA USA

[5] McMaster Univ & Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

[6] Goethe Univ Frankfurt, Dept Cardiol, D-60054 Frankfurt, Germany

[7] Boehringer Ingelheim Pharmaceut, Ridgefield, CT USA

[8] Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany

[9] Heidelberg Univ, Fac Med Mannheim, Heidelberg, Germany

[10] Univ Klinikum Duisburg Essen, Dept Neurol, Essen, Germany

[11] Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden

[12] Uppsala Univ, Dept Med Sci, Cardiol, Uppsala, Sweden

关键词: anticoagulation;    atrial fibrillation;    renal function;    thrombin inhibition;    vitamin K antagonist;   

DOI  :  10.1016/j.jacc.2015.03.577

来源: Elsevier

【 摘 要 】

BACKGROUND Vitamin K-dependent factors protect against vascular and renovascular calcification, and vitamin K antagonists may be associated with a decreased glomerular filtration rate (GFR). OBJECTIVES This study analyzed changes in GFR during long-term treatment with warfarin or dabigatran etexilate (DE) in patients enrolled in the RE-LY (Randomized Evaluation of Long Term Anticoagulation Therapy) trial. METHODS Of the 18,113 patients in the RE-LY study randomized to receive DE (110 mg or 150 mg twice daily) or warfarin, 16,490 patients with atrial fibrillation had creatinine values measured at baseline and at least 1 follow-up visit. Changes in GFR for up to 30 months were evaluated. RESULTS GFR declined in all treatment groups. After an average of 30 months, the mean +/- SE decline in GFR was significantly greater with warfarin (-3.68 +/- 0.24 ml/min) compared with DE 110 mg (-2.57 +/- 0.24 ml/min; p = 0.0009 vs. warfarin) and DE 150 mg (-2.46 +/- 0.23 ml/min; p = 0.0002 vs. warfarin). A decrease in GFR >25% was less likely with DE 110 mg (hazard ratio: 0.81 [95% confidence interval: 0.69 to 0.96]; p = 0.017) or DE 150 mg (hazard ratio: 0.79 [95% confidence interval: 0.68 to 0.93]; p = 0.0056) than with warfarin in the observation period >18 months. Patients with poor international normalized ratio control (i.e., time in therapeutic range <65%) exhibited a faster decline in GFR. A more pronounced decline in GFR was associated with previous warfarin use and with the presence of diabetes. CONCLUSIONS Patients with atrial fibrillation receiving oral anticoagulation exhibited a decline in renal function that was greater in those taking warfarin versus DE, and it was amplified by diabetes and previous vitamin K antagonist use. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

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