Kidney Week

Abstract: TH-PO1069

Oral Anticoagulant Prescribing in Atrial Fibrillation and CKD

Session Information

• CKD: Epidemiology, Risk Factors, and Other Conditions
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Xu, Yunwen, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Yunwen Xu, MS, PhD

• Chang, Alexander R., Geisinger Health, Danville, Pennsylvania, United States

Alexander R. Chang, MD, MS

• Inker, Lesley Ann, Tufts Medical Center, Boston, Massachusetts, United States

Lesley Ann Inker, MD, MS, FASN

• Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States

Morgan Grams, MD, PhD

• Shin, Jung-Im, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Jung-Im Shin, MD, PhD

Background

The 2024 KDIGO guidelines recommend routine consideration of oral anticoagulation for stroke prevention in patients with chronic kidney disease (CKD) and atrial fibrillation (AF), including those with low stroke risk (CHA₂DS₂-VASc score), for whom thromboprophylaxis was previously not advised. We aimed to examine prescribing patterns of oral anticoagulants across CKD stages and identify associated factors, using most contemporary data.

Methods

Using de-identified electronic health record data from the Optum Labs Data Warehouse, we identified adults with AF between October 2023 and September 2024 who had an indication for oral anticoagulation, defined as a CHA₂DS₂-VASc score ≥2 in men or ≥3 in women, or stages G3-4 CKD. We estimated the prevalence of oral anticoagulant prescriptions overall and within subgroups by CKD status and stroke risk and evaluated variations across health systems. We examined associations with individual- and health system-level characteristics.

Results

We identified 171,793 patients recommended for oral anticoagulants (mean age 75 years, 43% female, 87% White) from 16 health systems. Prevalence of oral anticoagulant prescription was similar among patients with and without CKD at high stroke risk (48% vs 48%), but lower (31%) among those with CKD and low stroke risk. Among patients at high stroke risk, advanced CKD stage was associated with lower prescribing, whereas no such trend was observed in the low-risk group (Figure A). Patient characteristics associated with lower likelihood of prescribing included younger age, female sex, Black or Hispanic race/ethnicity, higher bleeding risk (HAS-BLED score ≥2), and public or no insurance coverage. Prescribing patterns varied across health systems (Figure B), with higher rates observed in systems serving older populations and fewer racial/ethnic minorities or Medicaid beneficiaries.

Conclusion

The anticoagulation prescription remains low in patients with CKD and AF, underscoring the pressing need to implement the 2024 KDIGO guidelines.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20250vknqg3s