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Kidney Week

Abstract: PO0026

AKI and Bleeding Risks Associated with Vitamin K Antagonists and Antiplatelet Agents in Patients with CKD

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Laville, Solene M., CESP - INSERM U1018, Clinical Epidemiology Team, Paris-Saclay University, UVSQ, Villejuif, Île-de-France, France
  • Metzger, Marie, CESP - INSERM U1018, Clinical Epidemiology Team, Paris-Saclay University, UVSQ, Villejuif, Île-de-France, France
  • Hamroun, Aghiles, Regional and University Hospital Center of Lille, Nephrology Department, Lille, France
  • Lambert, Oriane, CESP - INSERM U1018, Clinical Epidemiology Team, Paris-Saclay University, UVSQ, Villejuif, Île-de-France, France
  • Jacquelinet, Christian, Agence de la biomedecine, La Plaine Saint-Denis, France
  • Laville, Maurice, Nephrology Dept, Centre Hospitalier Lyon Sud, Universite de Lyon, Carmen, Pierre-Bénite, France
  • Frimat, Luc, Nephrology Department, CHRU de Nancy, Vandoeuvre-les-Nancy, France
  • Fouque, Denis, Nephrology Dept, Centre Hospitalier Lyon Sud, Universite de Lyon, Carmen, Pierre-Bénite, France
  • Combe, Christian, Service de Nephrologie Transplantation Dialyse Apherese, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Stengel, Benedicte, CESP - INSERM U1018, Clinical Epidemiology Team, Paris-Saclay University, UVSQ, Villejuif, Île-de-France, France
  • Massy, Ziad, Department of Nephrology, Ambroise Pare University Hospital, APHP, Boulogne-Billancourt, France
  • Liabeuf, Sophie, Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
Background

Anticoagulation in patients with chronic kidney disease (CKD) is challenging because of altered pharmacodynamics/pharmacokinetics. Patients prescribed vitamin K antagonists (VKA) are at high risk of bleeding, and possibly also acute kidney injury (AKI). We assessed bleeding and AKI risks associated with VKA and/or antiplatelet agents (AP) prescription in patients with moderate or advanced CKD.

Methods

CKD-REIN is a prospective cohort of 3022 nephrology outpatients with CKD stages 2-5 at inclusion. Drug prescriptions and their duration were collected prospectively. We used cause-specific Cox proportional hazard models to estimate hazard ratios (HR) of bleeding (identified through hospitalizations) and AKI (as defined according to KDIGO 2012) associated with VKA only, AP only, or VKA + AP prescriptions treated as a time dependent variable and adjusted for baseline comorbidities, laboratory data, and medications.

Results

At baseline, 65% of the patients were men, median age was 69 (interquartile range (IQR), 60-76), median eGFR was 32 mL/min/1.73m2 (IQR, 23-41), 328 (10%) patients were prescribed VKA only, 1196 (40%) AP only, and 100 (3%) both VKA and AP.
Over a median follow-up of 3.0 years (IQR, 2.6-3.1), 71 (2%) patients were newly prescribed VKA and 187 (6%) AP; 152 patients experienced a bleeding event requiring hospital visit/stay (crude incidence rate (IR): 1.9% person-years [95%CI,1.6-2.2]) and 414 patients experienced AKI (crude IR: 5.4 % person-years [95%CI, 4.9-5.9].
The adjusted HRs for bleeding associated with prescriptions of AP only, VKA only and AP+VKA were 0.77 [95%CI, 0.48-1.22], 2.29 [95%CI, 1.41-3.73] and 3.77 [95%CI, 2.08-6.83], respectively.
Prescription of VKA was associated with increased AKI risk, adjusted HR, 1.79 [95%CI,1.39; 2.32], but not that of AP, 1.19 [95%CI, 0.94; 1.49].

Conclusion

This study confirms the high risk of AKI associated with VKA prescription in CKD patients. It also highlights the potential aggravating effect of combining VKA and AP on the risk of bleeding in this population.

Funding

  • Commercial Support