A systematic review of direct oral anticoagulant use in chronic kidney disease and dialysis patients with atrial fibrillation

Background: Chronic kidney disease (CKD) strongly predicts sudden cardiac death and may elevate the risk of certain cardiac arrhythmias like atrial fibrillation; however, the relationships between CKD and various types of arrhythmia are not well-characterized. Methods: We performed a systematic review and meta-analysis by searching Embase and PubMed for prospective, cross-sectional, and case-control studies examining the associations of two key CKD measures, estimated glomerular filtration rate (eGFR) and albuminuria, with arrhythmias in adults that were published until July 2018. We performed qualitative assessment of studies using the Newcastle Ottawa Quality Assessment Scale. We pooled the results using random-effects models. Results: Among 16,245 articles, we identified 34 prospective (n=24,213,233), 21 cross-sectional (n=253,328), and 4 case-control (n=1,694) studies that included diverse study populations from 19 countries and were mostly high quality. Most prospective studies examined the relationship between eGFR and atrial fibrillation (AF), and demonstrated that lower eGFR was associated with a higher risk of AF (pooled hazard ratio [HR] 1.72 [95% CI: 1.30, 2.27] comparing reduced vs. referent eGFR groups)[ Figure ]. A few studies examined albuminuria and demonstrated its associations with AF (pooled HR 2.16 [95% CI: 1.74, 2.67] comparing high vs. low albuminuria). Results were similar for cross-sectional studies. Four prospective studies reported a higher incidence of ventricular tachycardia resulting in ICD shock according to reduced eGFR (pooled HR 2.32 [95% CI: 1.74, 3.09] comparing reduced vs. referent eGFR groups). Limited number of studies examined other types of arrhythmia. Conclusion: We identified robust data on the relationship between CKD (eGFR and albuminuria) and AF. Reduced eGFR was associated with life-threatening ventricular arrhythmias. Our review highlights the need of future studies for non-AF arrhythmias, especially in the context of albuminuria.

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MP280A NEW ORAL ANTICOAGULANT THERAPY IN PATIENTS WITH NONDIALYSIS CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw188.36 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i432-i432

Author(s):

Ingrid Prkačin ◽

Tomislav Bulum ◽

Borna Vrhovec ◽

Lana Šambula ◽

Ana Legović ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

New Oral Anticoagulant

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Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents

Internal and Emergency Medicine ◽

10.1007/s11739-017-1753-2 ◽

2017 ◽

Vol 12 (8) ◽

pp. 1101-1108 ◽

Cited By ~ 10

Author(s):

Savino Sciascia ◽

Massimo Radin ◽

Karen Schreiber ◽

Roberta Fenoglio ◽

Simone Baldovino ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Vitamin K ◽

Oral Anticoagulant ◽

Vitamin K Antagonists ◽

Direct Oral Anticoagulant ◽

Anticoagulant Agents

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Comparison between Intravenous Iron and Oral Iron Preparations for the Treatment of Anemia of Chronic Kidney Disease - A Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood.v110.11.3748.3748 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3748-3748

Author(s):

Anat Gafter-Gvili ◽

Benaya Rozen-Zvi ◽

Mical Paul ◽

Leonard Leibovici ◽

Gafter Uzi ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Oral Iron ◽

Dialysis Patients ◽

Significant Difference ◽

All Cause Mortality ◽

Iron Preparation ◽

Iv Iron

Abstract Background: There is confounding data regarding the best method of iron supplementation in chronic kidney disease (CKD), without a consistent approach in clinical practice. Objectives: To evaluate the efficacy and safety of intravenous (IV) iron versus oral iron in patients treated for anemia of CKD. Methods: Systematic review and meta-analysis of randomized controlled trials comparing IV iron preparation with oral iron preparation for the treatment of anemia in patients with CKD (stage III, IV and V). The Cochrane Library, MEDLINE, conference proceedings and references were searched until 2007. Primary outcomes: absolute hemoglobin (Hb) level or change in Hb level from baseline at two months or at end of study; all-cause mortality. Secondary outcomes: need for renal replacement therapy (RRT) in predialysis patient and adverse events. Weighted mean differences (WMD) for outcomes with continuous variables and relative risks (RR) for dichotomous outcomes with 95% confidence intervals (CI) were estimated and pooled. Results: Our search yielded 11 trials which compared IV iron preparations (iron sucrose, iron gluconate or iron dextran) to oral iron. Compared to oral iron, there was a significant rise in Hb level in the IV iron treated hemodialysis patients (WMD 1.17; 95%CI 0.19–2.15, fig). Significant heterogeneity was observed due to different baseline Hb values and baseline iron status, different dosages of oral iron, and different dosages of erythropoiesis stimulating agents (ESA). For predialysis patients, there was a small but significant difference in the Hb level favoring the IV iron group (WMD 0.28; 95% CI 0.15–0.4, fig). For both groups effect estimates were not influenced by ESA administration. In predialysis patients, there was no significant difference in the risk for requiring RRT during the trial between the different groups (RR 0.63; 95%CI 0.25–1.65). Data on all-cause mortality were sparse (RR 0.54; 95%CI 0.09–3.13, 3 trials) and there was no difference in adverse events (RR 0.9; 95%CI 0.65–1.24) between the IV and oral treated patients. However, discontinuations of treatment were more common (RR 3.27; 95%CI 1.15–9.26) for the IV iron treated patients. Conclusions: Our review demonstrates that dialysis patients treated with IV iron have better Hb response than patients treated with oral iron. For predialysis patients, this effect is very small. IV iron should be preferred in the treatment of anemia in dialysis patients. In predialysis patients the slight advantage in Hb response should be weighed against the inconvenience and cost of IV iron treatment.

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Safety of antithrombotic drugs in patients with atrial fibrillation and non-end-stage chronic kidney disease: Meta-analysis and systematic review

Thrombosis Research ◽

10.1016/j.thromres.2015.11.020 ◽

2016 ◽

Vol 137 ◽

pp. 46-52 ◽

Cited By ~ 15

Author(s):

Ying Bai ◽

Hui Chen ◽

Yi Yang ◽

Li Li ◽

Xin-Yao Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Antithrombotic Drugs ◽

End Stage

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Telehealth for the management of blood pressure in patients with chronic kidney disease: A systematic review

Journal of Telemedicine and Telecare ◽

10.1177/1357633x17743276 ◽

2017 ◽

Vol 25 (2) ◽

pp. 80-92 ◽

Cited By ~ 2

Author(s):

Li Luo ◽

Meiqin Ye ◽

Jiaowang Tan ◽

Qiong Huang ◽

Xindong Qin ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Creatinine ◽

Randomised Controlled Trials ◽

Controlled Trials ◽

Dialysis Patients ◽

Significant Difference ◽

Randomised Controlled

Background Most patients with chronic kidney disease (CKD) fail to achieve blood pressure (BP) management as recommended. Meanwhile, the effects of promising intervention and telehealth on BP control in CKD patients remain unclear. We aimed to evaluate the efficacy of telehealth for BP in CKD non-dialysis patients. Methods Databases including MEDLINE, EMBASE, CENTRAL, CNKI, Wanfang, VIP and CBM were systematically searched for randomised controlled trials or quasi-randomised controlled trials on telehealth for BP control of CKD3-5 non-dialysis patients. We analysed systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), serum creatinine, and estimated glomerular filtration rate (eGFR) with a fixed-effects model. Results Three studies, with total 680 subjects, were included in our systematic review and two were included for meta-analysis. Pooled estimates showed decreased SBP (pooled mean difference (MD), −5.10; 95% confidence interval (CI), −11.34, 1.14; p > 0.05, p = 0.11), increased DBP (pooled MD, 0.45; 95% CI, −4.24, 5.13; p > 0.05, p = 0.85), decreased serum creatinine (pooled MD, −0.38; 95% CI, −0.83, 0.07; p > 0.05, p = 0.10) and maintained eGFR (pooled MD, 4.72; 95% CI, −1.85, 11.29; p > 0.05, p = 0.16) in the telehealth group. There was no significant difference from the control group. MAP (MD, 0.6; 95% CI, −6.61, 7.81; p > 0.05, p = 0.87) and BP control rate ( p > 0.05, p = 0.8), respectively, shown in two studies also demonstrated no statistical significance in the telehealth group. Conclusions There was no statistically significant evidence to support the superiority of telehealth for BP management in CKD patients. This suggests further studies with improved study design and optimised intervention are needed in the future.

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The impact of social disadvantage in moderate-to-severe chronic kidney disease: an equity-focused systematic review*

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfu394 ◽

2015 ◽

Vol 31 (1) ◽

pp. 46-56 ◽

Cited By ~ 33

Author(s):

Rachael Lisa Morton ◽

Iryna Schlackow ◽

Borislava Mihaylova ◽

Natalie Dawn Staplin ◽

Alastair Gray ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Health Insurance ◽

Kidney Disease ◽

Cardiovascular Events ◽

Home Ownership ◽

Dialysis Patients ◽

Low Education ◽

Severe Chronic Kidney Disease ◽

Event Rates

Abstract It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the ‘suitability’ of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance and no home ownership. Low income and no home ownership were associated with higher cardiovascular event rates and higher mortality [HR 1.94, 95% confidence interval (CI) 1.27–2.98; HR 1.28, 95% CI 1.04–1.58], respectively. In methodologically suitable studies among dialysis patients, females, ethnic minorities, those with low education, no health insurance, low occupational level or no home ownership were significantly less likely to access cardiovascular healthcare than their more advantaged dialysis counterparts. Low education level and geographic remoteness were associated with higher cardiovascular event rates and higher mortality (HR 1.54, 95% CI 1.01–2.35; HR 1.21, 95% CI 1.08–1.37), respectively. Socially disadvantaged pre-dialysis and dialysis patients experience poorer access to specialist cardiovascular health services, and higher rates of cardiovascular events and mortality than their more advantaged counterparts.

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