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. 2023 Jul 4:14:1210560.
doi: 10.3389/fphar.2023.1210560. eCollection 2023.

Medium-term and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation

Giuseppe Armentaro  1 , Graziella D'Arrigo  2 , Mario Bo  3 , Velia Cassano  1 , Sofia Miceli  1 , Annalisa Pitino  4 , Giovanni Tripepi  2 , Santina Maria Grazia Romeo  5 , Giorgio Sesti  6 , Gregory Y H Lip  7 , Daniele Pastori  8 , Mercedes Gori  4 , Angela Sciacqua  1
Affiliations

Medium-term and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation

Giuseppe Armentaro et al. Front Pharmacol. .

Abstract

Objective: Atrial Fibrillation (AF) and chronic kidney disease frequently coexist in the elderly. Warfarin-like drugs (WLDs) may be associated with a relatively greater decrease of estimated glomerular filtration rate (eGFR) as compared to direct oral anticoagulants (DOACs), but there is no evidence on the medium- and long-term changes. To further elucidate this issue in elderly patients with AF, we investigated the renal function deterioration in the two groups of the study (DOACs or WLDs). Patients and Methods: A total of 420 AF patients were enrolled (mean age: 77.0 ± 6.0 years; 136 on WLDs and 284 on DOACs). These patients underwent three eGFR measurements during the follow-up period. The between-arms difference of eGFR decline over time was investigated by Linear Mixed Models and group-based trajectory model analyses. Results: In the whole study cohort, after a median follow-up of 4.9 years (interquartile range: 2.7-7.0 years), eGFR decreased from 67.4 ± 18.2 to 47.1 ± 14.3 mL/min/1.73 m2 (p < 0.001). Remarkably, patients on DOACs experienced a significantly smaller eGFR decline than WLDs patients (-21.3% vs. -45.1%, p < 0.001) and this was true both in the medium-term (-6.6 vs. -19.9 mL/min/1.73 m2) and in the long-term (-13.5 versus -34.2 mL/min/1.73 m2) period. After stratification into five subgroups according to trajectories of renal function decline over time, logistic regression showed that DOACs patients had from 3.03 to 4.24-fold greater likelihood to belong to the trajectory with less marked eGFR decline over time than WLDs patients. Conclusion: Elderly patients with AF on treatment with DOACs had a relatively smaller decline of eGFR over time compared to those on treatment with WLDs. This is consistent with what was partly reported in the literature.

Keywords: DOACs; EGFR decline; atrial fibrillation; chronic kidney disease; elderly; warfarin-like drugs.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
the trajectories (n = 5) of eGFR evolution over time are plotted as a function of time. The dotted lines represent the 95% confidence intervals of each trajectory. In the bottom panel of the figure, the percentage of patients in each group-based trajectory is also reported. Abbreviation: eGFR, estimated glomerular filtration rate.
FIGURE 2
FIGURE 2
Individual evolution of eGFR over time in each group-based trajectory. Abbreviation: eGFR, estimated glomerular filtration rate.
See this image and copyright information in PMC

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