Changes in renal function in patients with atrial fibrillation: an analysis from the RE-LY trial
Vitamin K-dependent factors protect against vascular and renovascular calcification, and vitamin K antagonists may be associated with a decreased glomerular filtration rate (GFR). This study analyzed changes in GFR during long-term treatment with warfarin or dabigatran etexilate (DE) in patients enr...
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| Hauptverfasser: | , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
June 16, 2015
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| In: |
Journal of the American College of Cardiology
Year: 2015, Jahrgang: 65, Heft: 23, Pages: 2481-2493 |
| ISSN: | 1558-3597 |
| DOI: | 10.1016/j.jacc.2015.03.577 |
| Online-Zugang: | Verlag, teilw. kostenfrei, Volltext: http://dx.doi.org/10.1016/j.jacc.2015.03.577 Verlag, teilw. kostenfrei, Volltext: http://www.sciencedirect.com/science/article/pii/S0735109715018562 
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| Verfasserangaben: | Michael Böhm, MD; Michael D. Ezekowitz, MD, ChB, DPhil; Stuart J. Connolly, MD; John W. Eikelboom, MBBS; Stefan H. Hohnloser, MD; Paul A. Reilly, PhD; Helmut Schumacher, PhD; Martina Brueckmann, MD; Stephan H. Schirmer, MD, PhD; Mario T. Kratz, MD; Salim Yusuf, MD, DPhil; Hans-Christoph Diener, MD; Ziad Hijazi, MD; Lars Wallentin, MD, PhD |
| Zusammenfassung: | Vitamin K-dependent factors protect against vascular and renovascular calcification, and vitamin K antagonists may be associated with a decreased glomerular filtration rate (GFR). 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. 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. 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. 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. |
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| Beschreibung: | Gesehen am 14.12.2017 |
| Beschreibung: | Online Resource |
| ISSN: | 1558-3597 |
| DOI: | 10.1016/j.jacc.2015.03.577 |