Association of different oral anticoagulants use with renal function worsening in patients with atrial fibrillation. a multicentre cohort study

AIMS: To investigate the decline of estimated glomerular filtration rate (eGFR) in patients with atrial fibrillation (AF) treated with Vitamin K antagonists (VKAs) or non-VKAs oral anticoagulants (NOACs). METHODS:Multicentre prospective cohort study including 1,667 patients with non-valvular AF. The eGFR was assessed by the CKD-EPI formula at baseline and during follow-up. The primary endpoint of the study was the median annual decline of eGFR according to VKAs (n=743) or NOACs (n=924) use. As secondary endpoints, we analysed the transition to eGFR <50 ml/min/1.73 m2 , and the eGFR class worsening. RESULTS:Median age was 73.7±9.1 years and 43.3% were women. VKAs-treated patients showed an eGFR decline of -2.11 (Interquartile Range [IQR] -5.68/-0.62], which was -0.27 [IQR -9.00/4.54] (p<0.001 vs. VKAs), -1.21 [IQR -9.98/4.02] (p=0.004 vs. VKAs) and -1.32 [IQR -8.70/3.99] (p=0.003 vs. VKAs) in patients on Dabigatran Rivaroxaban and Apixaban, respectively. Transition to eGFR <50 mL/min/1.73 m2 , was lower in Dabigatran and Apixaban treated patients: Odds Ratio (OR) 0.492, 95% Confidence Interval (CI) 0.298-0.813, p=0.006 and OR 0.449, 95%CI 0.276-0.728, p=0.001, respectively. A lower rate of eGFR class worsening was found in all groups of NOACs compared to VKAs. No difference between full and reduced dose of NOAC was found. Subgroup analysis showed that the association between NOAC and eGFR changes was markedly reduced in diabetic patients. CONCLUSION: Patients prescribed on NOACs showed a lower decline of renal function compared to those on VKAs. This effect was partially lost in patients with diabetes.