PB0019 - Direct Oral Anticoagulants and Risk of Kidney Disease

Background: Oral anticoagulant therapy may be associated with kidney complications. Observational studies suggest lower risks associated with direct oral anticoagulants (DOACs) compared to vitamin K-antagonists (VKAs).

Aims: Our aim was to study the effects of oral anticoagulants on the development/progression of kidney disease.

Methods: We studied patients who started oral anticoagulants within three months after an incident atrial fibrillation diagnosis during 2014 to 2019. Using routinely collected creatinine measurements, we followed patients in an intension-to-treat approach for acute kidney injury (AKI) and chronic kidney disease (CKD) progression. AKI was defined according to the KDIGO criteria; CKD progression was a composite of >25% decline in eGFR or kidney failure. Propensity-score weighting was used to balance baseline confounders; we reported weighted absolute risks using the Cohort Estimator and weighted hazard ratios (HRs) using Cox regression. Consistency was checked within prespecified subgroups.

Results: We included 384 persons with AF initiating oral anticoagulation with 69.0% in the DOAC cohort. The median age was 52 years, 46.3% were women, and 29.9% had a eGFR < 60 ml/min/1.73 m2. The median follow-up was 2.1 years. Absolute risks of kidney complications were high: During the first year of treatment the risk of AKI was 13.2% in the DOAC and 19.3% in the VKA group; the 4-year risk of CKD progression was 15.5% in DOAC and 22.6% in VKA users. Compared with VKAs, DOAC treated patients had lower rates of both AKI and CKD progression with HRs of 0.86 and 0.87 (95% CI) respectively. Results were similar across subgroups of age, sex, baseline eGFR.

Conclusion(s): Kidney complications were common among AF patients initiating oral anticoagulants. DOAC initiators had lower absolute risks and corresponding lower rates of AKI and CKD progression than initiators of VKAs. These data are from single medical center and multicenter randomized controlled trials are required to obtain more detailed findings.