Oral anticoagulants in patients with chronic kidney disease and atrial fibrillation

The aim of this study was to investigate the effects of new/direct oral anticoagulants (DOACs) on renal function parameters in chronic kidney disease patients with estimated glomerular filtration rate (eGFR) > 30 mlmin-11.73m2. A total of 40 chronic kidney disease patients with normal, mildly or moderately decreased renal function and non valvular atrial fibrillation were included (Group A) and were followed for 12 months. Dabigatran was started as 150 mg twice daily dose and rivaroxaban 20 mg once daily in patients with eGFR >= 50 mlmin11.73m2. In patients with eGFR < 50 and > 30 mlmin-11.73m2 dabigatran was started as 110 twice daily dose and rivaroxaban 15 mg once daily. Apixaban was started 2.5mg twice daily. In group B there were 200 patients on warfarin for non valvular atrial fibrillation. Calculated HAS-BLED score was 2.8 (A) and 2.9 (B) and mean CHA2DS2VASc score was of 2.9 (A) and 3.1 (B). Changes in eGFR for up to12 months were evaluated. Treatment with warfarin caused a significant eGFR declined from 56 +/- 21 mlmin-11.73m2 to 51 +/- 19 (p<0.001), and 30% (62 of 200) of the patients had adverse events (31%). In patients on dabigatran and rivaroxaban, in both dosing regimens, and apixaban, eGFR (from 58 +/- 23 mlmin-11.73m2 to 58 +/- 19 mlmin11.73m2 (p=0.01)) did not change, with significantly less adverse events (12% of patients). The results of our study suggest that therapy with new/direct oral anticoagulants (non-VKA oral anticoagulants) have a better bleeding risk profile and less decline in eGFR compared with vitamin K antagonists.