Deterioration of renal function is delayed in patients with atrial fibrillation treated with direct oral anticoagulants compared to vitamin K antagonists: systematic review and meta-analysis.

Abstract

The use of anticoagulants has been linked to anticoagulant-related nephropathy, a condition initially reported in patients treated with warfarin. However, cases have also been documented in patients receiving direct oral anticoagulants (DOACs). We conducted a systematic review and meta-analysis to assess the comparative effect of DOACs versus Vitamin K antagonists (VKAs) in renal function deterioration in atrial fibrillation (AF) population. According to the PRISMA reporting guidelines for systematic reviews and meta-analyses, we performed a comprehensive search in PubMed/MEDLINE and EMBASE (via Scopus), focusing on studies in AF patients treated with DOACs or VKAs and assessing their renal function over time. The studied outcomes were ≥30 % eGFR decline, progression to stage five chronic kidney disease (CKD) and doubling of serum creatinine. Among 4566 records, 13 studies with 302,071 patients were included with an overall follow-up period of 701,421.5 patient-years (mean:2.3 years per patient). DOACs were associated with a lower risk of ≥30 % eGFR decline (HR:0.72, 95 %CI:0.59-0.88), progression to stage five CKD (HR:0.49,95 %CI:0.37-0.64) and doubling of serum creatinine (HR:0.50, 95 %CI:0.42-0.61). ≥30 % eGFR decline was also lower when apixaban, dabigatran and rivaroxaban were compared separately to VKAs, (HR:0.81, 95 %CI:0.69-0.95), (HR:0.61, 95 %CI:0.48-0.78) and (HR:0.80, 95 %CI:0.70-0.92) respectively. There was no effect in progression to stage five CKD and doubling of serum creatinine, when apixaban was compared to VKAs. This systematic review and metanalysis of 13 studies and >300,000 patients with AF followed for an overall period of >700,000 patient-years showed that eGFR decline, progression to stage five CKD and doubling of serum creatinine are delayed in patients treated with DOACs compared to VKAs.