Armentaro, Giuseppe, D'Arrigo, Graziella, Bo, Mario, Cassano, Velia, Miceli, Sofia, Pitino, Annalisa, Tripepi, Giovanni, Romeo, Santina Maria Grazia 
ORCID: 0000-0002-4973-4078, Sesti, Giorgio, Lip, Gregory YH ORCID: 0000-0002-7566-1626 et al (show 3 more authors)
(2023)
Medium-term and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation.
Frontiers in pharmacology, 14.
1210560-.
Abstract
<b>Objective:</b> Atrial Fibrillation (AF) and chronic kidney disease frequently coexist in the elderly. Warfarin-like drugs (WLDs) may be associated with a relatively greater decrease of estimated glomerular filtration rate (eGFR) as compared to direct oral anticoagulants (DOACs), but there is no evidence on the medium- and long-term changes. To further elucidate this issue in elderly patients with AF, we investigated the renal function deterioration in the two groups of the study (DOACs or WLDs). <b>Patients and Methods:</b> A total of 420 AF patients were enrolled (mean age: 77.0 ± 6.0 years; 136 on WLDs and 284 on DOACs). These patients underwent three eGFR measurements during the follow-up period. The between-arms difference of eGFR decline over time was investigated by Linear Mixed Models and group-based trajectory model analyses. <b>Results:</b> In the whole study cohort, after a median follow-up of 4.9 years (interquartile range: 2.7-7.0 years), eGFR decreased from 67.4 ± 18.2 to 47.1 ± 14.3 mL/min/1.73 m<sup>2</sup> (<i>p</i> < 0.001). Remarkably, patients on DOACs experienced a significantly smaller eGFR decline than WLDs patients (-21.3% vs. -45.1%, <i>p</i> < 0.001) and this was true both in the medium-term (-6.6 vs. -19.9 mL/min/1.73 m<sup>2</sup>) and in the long-term (-13.5 <i>versus</i> -34.2 mL/min/1.73 m<sup>2</sup>) period. After stratification into five subgroups according to trajectories of renal function decline over time, logistic regression showed that DOACs patients had from 3.03 to 4.24-fold greater likelihood to belong to the trajectory with less marked eGFR decline over time than WLDs patients. <b>Conclusion:</b> Elderly patients with AF on treatment with DOACs had a relatively smaller decline of eGFR over time compared to those on treatment with WLDs. This is consistent with what was partly reported in the literature.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DOACs, EGFR decline, atrial fibrillation, chronic kidney disease, elderly, warfarin-like drugs |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 13 Oct 2023 13:33 |
| Last Modified: | 18 Mar 2024 03:31 |
| DOI: | 10.3389/fphar.2023.1210560 |
| Open Access URL: | https://doi.org/10.3389/fphar.2023.1210560 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173696 |
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