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Abstract: TH-OR04

Oral Anticoagulant Therapy and Risk of Kidney Disease: A Nationwide Cohort Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Vestergaard, Ane Emilie Friis, Aarhus Universitet Klinisk Epidemiologisk Afdeling, Aarhus, Midtjylland, Denmark
  • Jensen, Simon Kok, Aarhus Universitet Klinisk Epidemiologisk Afdeling, Aarhus, Midtjylland, Denmark
  • Heide-Jørgensen, Uffe, Aarhus Universitet Klinisk Epidemiologisk Afdeling, Aarhus, Midtjylland, Denmark
  • Adelborg, Kasper, Aarhus Universitet Klinisk Epidemiologisk Afdeling, Aarhus, Midtjylland, Denmark
  • Birn, Henrik, Aarhus Universitet Institut for Biomedicin, Aarhus, Denmark
  • Carrero, Juan Jesus, Karolinska Institutet Institutionen for medicinsk epidemiologi och biostatistik, Stockholm, Stockholm, Sweden
  • Christiansen, Christian Fynbo, Aarhus Universitet Klinisk Epidemiologisk Afdeling, Aarhus, Midtjylland, Denmark
Background

Oral anticoagulant therapy may be associated with kidney complications. Emerging evidence from observational studies suggest lower risks associated with direct oral anticoagulants (DOACs) compared to vitamin K-antagonists (VKAs). However, these studies suffer from methodological limitations, which we aimed to address using the unique Danish setting of population-based medical databases.

Methods

We conducted a new user active comparator cohort study in patients who started oral anticoagulant drug use within three months after an incident atrial fibrillation diagnosis during 2012 to 2018. Using routinely collected creatinine measurements from laboratory databases, 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 >30% decline in estimated glomerular filtration rate (eGFR) or kidney failure. Propensity-score weighting was used to balance baseline confounders; we reported weighted absolute risks using the Aalen-Johansen estimator and weighted hazard ratios (HRs) using Cox regression. Consistency was checked within prespecified subgroups.

Results

We included 33,670 persons with atrial fibrillation initiating oral anticoagulation with 77% in the DOAC cohort. The median age was 75 years, 48% were women, and 25% had a baseline eGFR <60 ml/min/1.73 m2. The median follow-up was 2.3 years. Absolute risks of kidney complications were high: During the first year of treatment the cumulative risk of AKI was 13.9% in the DOAC group and 15.5% in the VKA group; the 5-year risk of CKD progression was 14.0% in DOAC users and 15.4% in VKA users. Compared to VKA initiation, DOAC treated patients had lower rates of both AKI and CKD progression with HRs of 0.85 (95% CI [0.81; 0.89]) and 0.84 (95% CI [0.78; 0.91]) respectively. Results were similar across subgroups of age, sex, baseline eGFR, and diabetes.

Conclusion

Kidney complications were common among atrial fibrillation patients initiating oral anticoagulant drugs. DOAC initiators had lower absolute risks and corresponding lower rates of AKI and CKD progression than initiators of VKAs.

Funding

  • Private Foundation Support