AKI, CKD Progression Less Likely With Direct Oral Anticoagulants

Acute kidney injury (AKI) and chronic kidney disease (CKD) progression are less likely with direct oral anticoagulants (DOACs) vs vitamin K antagonists for atrial fibrillation, investigators reported at the American Society of Nephrology’s Kidney Week 2022 conference in Orlando, Florida.

Ane Emilie Friis Vestergaard, MD, of Aarhus Universitet Klinisk Epidemiologisk Afdeling in Aarhus, Denmark, and colleagues conducted an active comparative study that included 33,670 patients with atrial fibrillation initiating anticoagulant therapy. Of these, 77% started therapy with DOACs. Patients had a mean age of 75 years, 48% were women, and 25% had an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m². The median follow-up was 2.3 years.

During the first year of treatment, the cumulative risk for AKI was 13.9% in the DOAC group and 15.5% in the vitamin K antagonist group. The 5-year risk for CKD progression was 14.0% in the DOAC group and 15.4% among vitamin K antagonist users.

Compared with vitamin K antagonist users, those in the DOAC group had significant 15% and 16% lower risks for AKI and CKD progression, respectively, Dr Vestergaard’s team reported. Results were similar across subgroups of sex, age, diabetes, and baseline eGFR.

The investigators defined AKI according to KDIGO criteria and CKD progression as a composite of a greater than 30% decrease in eGFR or kidney failure.

Want to read more?