Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Dynamics of Kidney Function in Patients with Chronic Kidney Disease and Atrial Fibrillation Who Receive Dabigatran

https://doi.org/10.20996/1819-6446-2021-04-04

Full Text:

Abstract

Atrial fibrillation (AF) is the most frequent type of supraventricular arrhythmias. The anticoagulant therapy should be prescribed to prevent thromboembolic events. According to randomized clinical trials, anticoagulants do not always prove their high efficiency in the real clinical practice. It is a complicated issue for any doctor to prescribe the anticoagulant therapy for patients with AF and CKD. 30 % of patients with atrial fibrillation are known to have chronic kidney disease, while 10-15% of patients with chronic kidney disease are diagnosed with atrial fibrillation. Currently, there are scarce studies into the use of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease (in case of Glomerular Filtration Rate (GFR) below 45 ml/min/1.73 m2).

Aim. To determine the dynamics of GFR in patients with AF and CKD (in case of GFR below 45 ml/min/1.73 m2).

Material and Methods. The sub-analysis was carried out to examine a single-centre prospective study into the optimization of the anticoagulant therapy in the outpatient practice. Initially, 133 dabigatran taking patients were enrolled in the study, and 79 patients were included in the final analysis. Endpoints were changes in Glomerular Filtration Rate (CKD-EPI) formulae as of the inclusion date, in 6, 12, 24 and 60 months after the inclusion. Changes in the renal function shall mean a decrease or increase in GFR by ≥5 ml/min.

Results. The average follow-up period for patients was 1785 ± 218 days. A GFR>45 ml/min/1.73 m2 occurred in 116 (87.2%) patients, and a GFR <45 ml/min/1.73 m2 was found in 17 (12.8%) patients. The average HAS-BLED score was 1.8, and CHA2DS2VASc score - 3.8. During the observation period, there were 3 cases of major bleeding and 133 cases of minor bleeding. Both major (р=0.025) and minor (р=0.012) bleeding were statistically significant more frequent in patients with GFR below 45 ml/min. During 5 years of follow-up, 66 (49.6%) patients had an average decrease in GFR of 3.32 ml/min/1.73 m2 per year. Patients with the initially declined GFR (below 45 ml/min) did not demonstrate a significant dynamic of the renal function during the dabigatran therapy. The mortality rate in this group during the observation period was 61.5%.

Conclusion. In 49.6% of patients during 5 years of follow-up, GFR decreased by an average of 3.32 ml/min/1.73 m2 per year, which does not exceed the indicators typical for patients with cardiovascular events and CKD.

About the Authors

N. A. Novikova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Nina A. Novikova - eLibrary SPIN 7876-8609.

Moscow



Z. K. Salpagarova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Zukhra K. Salpagarova - eLibrary SPIN 7769-9637.

Moscow



M. I. Chashkina
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Maria I. Chashkina - eLibrary SPIN 3318-4979.

Moscow



A. A. Bykova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Aleksandra A. Bykova - eLibrary SPIN 8234-0523.

Moscow



Z. A. Alimova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Zulfiya A. Alimova - eLibrary SPIN 7188-8274.

Moscow



А. S. Yadykina
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Anastasia S. Yadykina - eLibrary SPIN 2758-3152.

Moscow



D. F. Mesitskaya
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Dinara F. Mesitskaya - eLibrary SPIN 2758-3152.

Moscow



N. A. Babakova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Nadezhda A. Babakova

Moscow



D. A. Andreev
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Denis A. Andreev - eLibrary SPIN 8790-8834

Moscow



References

1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47. DOI:10.1161/CIRCULATIONAHA.113.005119.

2. Yakusevich VV, Pozdnyakova EM, Yakusevich VV, et al. Atrial fibrillation outpatient: basic characteristics. The first data of the register REKVAZA FP-YAROSLAVL. Rational Pharmacotherapy in Cardiology. 2015;11(2):149-52 (In Russ.) DOI:10.20996/1819-6446-2015-11-2-149-152.

3. Valiakhmetov MN, Gomova TA, Lukyanov MM, et al. Patients with atrial fibrillation in a multidisciplinary hospital: hospitalization structure, concomitant cardiovascular diseases and drug therapy (data from the REKVAZA FP-TULA register). Rational Pharmacotherapy in Cardiology. 2017;13(4):495- 505 (In Russ.) DOI:10.20996/1819-6446-2017-13-4-495-505.

4. Tuchkov AA, Gogolashvili NG, Yaskevich RA. Assessment of the dynamics of antithrombotic therapy in patients with atrial fibrillation during 2015-2017. According to the register of the clinic of the Scientific Research Institute of Medical Problems of the North of Krasnoyarsk. Rational Pharmacotherapy in Cardiology. 2019;15(1):43-8 (In Russ.) DOI:10.20996/1819-6446-2019-15-1-43-48.

5. Chashkina MI, Kozlovskaya NL, Andreev DA, et al. Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in Cardiology Departments. Kardiologiia. 2020;60(2):41-6 (In Russ.) DOI:10.18087/cardio.2020.2.n823.

6. Patino MI, Kraus P, Bishop MA. Implementation of patient education software in an anticoagulation clinic to decrease visit times for new patient appointments. Patient Educ Couns. 2019;102(5):961-7. DOI:10.1016/j.pec.2018.12.023.

7. Haut ER, Aboagye JK, Shaffer DL, et al. Effect of Real-time Patient-Centered Education Bundle on Administration of Venous Thromboembolism Prevention in Hospitalized Patients. JAMA Netw Open. 2018;1(7):e184741. DOI:10.1001/jamanetworkopen.2018.4741.

8. Reinecke H, nabauer M, Gerth A, et al. Morbidity and treatment in patients with atrial fibrillation and chronic kidney disease. Kidney International. 2015;87(1):200-9. DOI:10.1038/ki.2014.195.

9. Albrecht D, Turakhia M, Ries D, et al. Pharmacokinetics of Tecarfarin and Warfarin in Patients with Severe Chronic Kidney Disease. Thrombosis and Haemostasis. 2017;117(11):2026-33. DOI:10.1160/TH16-10-0815.

10. Lea-Henry TN, Carland JE, Stocker SL, et al. Clinical Pharmacokinetics in Kidney Disease: Fundamental Principles. Clinical Journal of the American Society of Nephrology. 2018;13(7):1085-95. DOI:10.2215/CJN.00340118.

11. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine. 2011;365(10):883-91. DOI:10.1056/NEJMoa1009638.

12. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine. 2011;365(11):981-92. DOI:10.1056/NEJMoa1107039.

13. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine. 2009;361(12):1139-51. DOI:10.1056/ NEJ- Moa0905561.

14. Hohnloser SH, Hijazi Z, Thomas L, et al. Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. European Heart Journal. 2012;33(22):2821-30. DOI:10.1093/eurheartj/ehs274.

15. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39:1330-93. DOI:10.1093/eurheartj/ehy136.

16. Molteni M, Crippa M, Orenti A, et al. Investigation on Dabigatran Etexilate and Worsening of Renal Function in Patients with Atrial fibrillation: The IDEA Study. Clin Drug Investig. 2019;39(4):355- 362. DOI:10.1007/s40261-018-0742-1.

17. Keller C, Katz R, Sarnak MJ, et al. Inflammatory biomarkers and decline in kidney function in the el- derty: the Cardiovascular Health Study. Nephrol Dial Transplant. 2010;25:119-24. DOI:10.1093/ndt/gfp429.

18. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020;98(4S):S1-S115. DOI:10.1016/j.kint.2020.06.019.

19. Yao X., Tangri N, Gersh BJ, et al. Renal Outcomes in anticoagulated patients with atrial fibrillation. JACC. 2017:70:2621-32. DOI:10.1016/j.jacc.2017.09.1087.


For citation:


Novikova N.A., Salpagarova Z.K., Chashkina M.I., Bykova A.A., Alimova Z.A., Yadykina А.S., Mesitskaya D.F., Babakova N.A., Andreev D.A. Dynamics of Kidney Function in Patients with Chronic Kidney Disease and Atrial Fibrillation Who Receive Dabigatran. Rational Pharmacotherapy in Cardiology. 2021;17(2):186-192. https://doi.org/10.20996/1819-6446-2021-04-04

Views: 227


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)