Table 3.
Kidney outcomes of patients with nonvalvular atrial fibrillation on VKAs versus DOACs
| Author | Database | N | Treatment arm | Follow-up | Acute kidney injury HR (95% CI) | Annual decline in GFR | CKD progression HR (95% CI) | Progression to kidney failure HR (95% CI) |
|---|---|---|---|---|---|---|---|---|
| Fordyce et al. [93] | ROCKET-AF trial | 12,612 | Rivaroxaban | – | – | −4.3±14.6 | – | – |
| Warfarin | −3.5±15.1 | |||||||
| Hijazi et al. [94] | ARISTOTLE trial | 16,869 | Apixaban | – | – | −1.4±10.1 | – | – |
| Warfarin | −0.9±10.3 | |||||||
| Böhm et al. [92] | RE-LY trial | 16,490 | Dabigatran 110 | 30 months | 0.81 (0.69–0.96) | −3.7±0.2 | 0.75 (0.62–0.92) | – |
| Dabigatran 150 | 0.66 (0.54–0.81) (reference) | −2.5±0.2 | 0.66 (0.54–0.81) | |||||
| Warfarin | −3.7±0.2 | (reference) | ||||||
| Yao et al. [91] | Optum Labs Warehouse (USA) | 9,769 | Dabigatran | 11±10 months | – | – | 0.45 (0.13–1.59) | |
| Apixaban | 1.02 (0.45–2.31) | |||||||
| Rivaroxaban | 0.63 (0.35–1.15) | |||||||
| All DOACs | 0.68 (0.58–0.81) | |||||||
| Warfarin | (reference) | (reference) | ||||||
| Hernandez et al. [96] | US IBM Market Scan | 21,682 | Rivaroxaban | 1.7 y (0.8–3.2) | 0.83 (0.74–0.92) | – | – | 0.82 (0.70–0.96) |
| Warfarin | (reference) | (reference) | ||||||
| Trevisan et al. [100] | SCREAM project | 32,699 | DOACs | 3.8 y | 0.88 (0.80–0.97) | 0.87 (0.78–0.98) | 0.43 (0.25–0.73) | |
| Warfarin | (reference) | (reference) | (reference) | |||||
| Chan et al. [95] | Taiwan National Registry | 19,932 | Dabigatran | 0.69 y | 0.56 (0.46–0.69) | – | – | – |
| Warfarin | 0.79 y | (reference) | ||||||
| Lin et al. [99] | Taiwan multi-center database | 2,382 | DOAC | 2.3±2.1 y | – | – | 0.75 (0.64–0.87) | 0.94 (0.78–1.12) |
| Warfarin | 2.6±2.3 y | (reference) | (reference) | |||||
| Wang et al. [101] | Taiwan single center database | 2,203 | Dabigatran | – | 0.94 (0.56–1.56) | – | 0.69 (0.50–0.95) | 0.56 (0.27–1.18) |
| Rivaroxaban | 1.06 (0.76–1.47) | 1.04 (0.86–1.30) | 0.83 (0.55–1.25) | |||||
| Edoxaban | 1.05 (0.64–1.72) | 1.2 (0.92–1.57) | 0.81 (0.42–1.55) | |||||
| Warfarin | (reference) | (reference) | (reference) | |||||
| Wetmore et al. [98] | US Medicare beneficiaries | 12,816 | Apixaban | 466±374 d | – | – | 0.90 (0.82–0.99) | – |
| Warfarin | 664±374 d | (reference) | ||||||
| Pastori et al. [97] | Italy | 1,667 | Dabigatran | 1 y | – | −0.3 (−9.0 to +4.5) | 0.70 (0.50–0.97) | – |
| Apixaban | −1.2 (−9.9 to +4.0) | 0.59 (0.42–0.82) | ||||||
| Rivaroxaban | −1.3 (−8.7 to +3.9) | 0.59 (0.43-0.81) | ||||||
| Warfarin | (reference) | (reference) |
CI, confidence interval; CKD, chronic kidney disease; d, days; DOACs, direct oral anticoagulants; GFR, glomerular filtration rate (in mL/min/1.73 m2/year); HR, hazard ratio; N, total number of patients; y, years.