BACKGROUND: The purpose of this study is to assess incidence and risk factors for severe renal dysfunction in patients requiring oral anticoagulation to help guide initial drug choice and provide a rational basis for interval monitoring of renal function for patients prescribed non-vitamin K oral anticoagulants. METHODS: Patients on warfarin for atrial fibrillation or venous thromboembolism were consecutively enrolled from January 2007 to December 2010. Baseline kidney function was assessed, and patients were followed to their first decline of kidney function to creatinine clearance<30 mL/min. Multivariate regression assessed independent risk factors for the primary outcome. Severe renal impairment based on baseline kidney function was assessed by Kaplan-Meier analyses. RESULTS: Of 787 patients identified, 34 were excluded for baseline CrCl <30 mL/min. The mean age was 71 years, and 74% and 31% had hypertension and diabetes mellitus, respectively. At baseline, 23% (n=174) had moderate chronic kidney disease (CKD) (CrCl 30-59mL/min), whereas 31% had mild CKD (CrCl 60-89mL/min). Severe renal impairment occurred in 92 patients (12%), 25% of which was seen within 5.3 months. Of those with baseline stage 3 CKD, 37% developed severe renal impairment. Stage 3 CKD conferred a 14-fold increased risk in the development of severe renal dysfunction (odds ratio 14.5, 95% CI 6.7-31.3, P<.001). Coronary artery disease was also associated with severe renal impairment (odds ratio 2.2, 95% CI 1.3-3.8, P=.004). CONCLUSIONS: Acute and chronic renal dysfunction is common among individuals requiring long-term anticoagulant therapy. Patients with moderate chronic kidney disease and coronary artery disease are at the highest short-term risk of developing severe renal impairment. More frequent monitoring of these patients is warranted.
BACKGROUND: The purpose of this study is to assess incidence and risk factors for severe renal dysfunction in patients requiring oral anticoagulation to help guide initial drug choice and provide a rational basis for interval monitoring of renal function for patients prescribed non-vitamin K oral anticoagulants. METHODS:Patients on warfarin for atrial fibrillation or venous thromboembolism were consecutively enrolled from January 2007 to December 2010. Baseline kidney function was assessed, and patients were followed to their first decline of kidney function to creatinine clearance<30 mL/min. Multivariate regression assessed independent risk factors for the primary outcome. Severe renal impairment based on baseline kidney function was assessed by Kaplan-Meier analyses. RESULTS: Of 787 patients identified, 34 were excluded for baseline CrCl <30 mL/min. The mean age was 71 years, and 74% and 31% had hypertension and diabetes mellitus, respectively. At baseline, 23% (n=174) had moderate chronic kidney disease (CKD) (CrCl 30-59mL/min), whereas 31% had mild CKD (CrCl 60-89mL/min). Severe renal impairment occurred in 92 patients (12%), 25% of which was seen within 5.3 months. Of those with baseline stage 3 CKD, 37% developed severe renal impairment. Stage 3 CKD conferred a 14-fold increased risk in the development of severe renal dysfunction (odds ratio 14.5, 95% CI 6.7-31.3, P<.001). Coronary artery disease was also associated with severe renal impairment (odds ratio 2.2, 95% CI 1.3-3.8, P=.004). CONCLUSIONS: Acute and chronic renal dysfunction is common among individuals requiring long-term anticoagulant therapy. Patients with moderate chronic kidney disease and coronary artery disease are at the highest short-term risk of developing severe renal impairment. More frequent monitoring of these patients is warranted.
Authors: Elsayed Z Soliman; Ronald J Prineas; Alan S Go; Dawei Xie; James P Lash; Mahboob Rahman; Akinlolu Ojo; Val L Teal; Nancy G Jensvold; Nancy L Robinson; Daniel L Dries; Lydia Bazzano; Emile R Mohler; Jackson T Wright; Harold I Feldman Journal: Am Heart J Date: 2010-06 Impact factor: 4.749
Authors: Andrew S Levey; Josef Coresh; Ethan Balk; Annamaria T Kausz; Adeera Levin; Michael W Steffes; Ronald J Hogg; Ronald D Perrone; Joseph Lau; Garabed Eknoyan Journal: Ann Intern Med Date: 2003-07-15 Impact factor: 25.391
Authors: Stuart J Connolly; Michael D Ezekowitz; Salim Yusuf; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S Lewis; Harald Darius; Hans-Christoph Diener; Campbell D Joyner; Lars Wallentin Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Nita A Limdi; T Mark Beasley; Melissa F Baird; Joyce A Goldstein; Gerald McGwin; Donna K Arnett; Ronald T Acton; Michael Allon Journal: J Am Soc Nephrol Date: 2009-02-18 Impact factor: 10.121
Authors: Marcel Levi; G Kees Hovingh; Suzanne C Cannegieter; Marinus Vermeulen; Harry R Büller; Frits R Rosendaal Journal: Blood Date: 2008-03-03 Impact factor: 22.113
Authors: Alan S Go; Margaret C Fang; Natalia Udaltsova; Yuchiao Chang; Niela K Pomernacki; Leila Borowsky; Daniel E Singer Journal: Circulation Date: 2009-03-02 Impact factor: 29.690
Authors: Pietro Scicchitano; Marco Tucci; Maria Consiglia Bellino; Francesca Cortese; Annagrazia Cecere; Micaela De Palo; Francesco Massari; Pasquale Caldarola; Francesco Silvestris; Marco Matteo Ciccone Journal: Cardiovasc Drugs Ther Date: 2021-06 Impact factor: 3.727