Incidence of severe renal dysfunction among individuals taking warfarin and implications for non–vitamin K oral anticoagulants

Christina L. Fanola, Deirdre Mooney, Andrew J. Cowan, Darae Ko, Emily K. Sisson, Lori E. Henault, Yorghos Tripodis, Elaine M. Hylek

Research output: Contribution to journalArticle

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Abstract

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 30-59 mL/min), whereas 31% had mild CKD (CrCl 60-89 mL/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.

Original languageEnglish (US)
Pages (from-to)150-155
Number of pages6
JournalAmerican Heart Journal
Volume184
DOIs
StatePublished - Feb 1 2017

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Warfarin
Anticoagulants
Kidney
Incidence
Chronic Renal Insufficiency
Coronary Artery Disease
Odds Ratio
Venous Thromboembolism
Kaplan-Meier Estimate
Physiologic Monitoring
Atrial Fibrillation
Creatinine
Diabetes Mellitus
Hypertension

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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Incidence of severe renal dysfunction among individuals taking warfarin and implications for non–vitamin K oral anticoagulants. / Fanola, Christina L.; Mooney, Deirdre; Cowan, Andrew J.; Ko, Darae; Sisson, Emily K.; Henault, Lori E.; Tripodis, Yorghos; Hylek, Elaine M.

In: American Heart Journal, Vol. 184, 01.02.2017, p. 150-155.

Research output: Contribution to journalArticle

Fanola, Christina L. ; Mooney, Deirdre ; Cowan, Andrew J. ; Ko, Darae ; Sisson, Emily K. ; Henault, Lori E. ; Tripodis, Yorghos ; Hylek, Elaine M. / Incidence of severe renal dysfunction among individuals taking warfarin and implications for non–vitamin K oral anticoagulants. In: American Heart Journal. 2017 ; Vol. 184. pp. 150-155.
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AU - Mooney, Deirdre

AU - Cowan, Andrew J.

AU - Ko, Darae

AU - Sisson, Emily K.

AU - Henault, Lori E.

AU - Tripodis, Yorghos

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N2 - 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 30-59 mL/min), whereas 31% had mild CKD (CrCl 60-89 mL/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.

AB - 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 30-59 mL/min), whereas 31% had mild CKD (CrCl 60-89 mL/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.

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