scholarly journals POS0643 ARE BIOLOGIC AND TARGETED SYNTHETIC DMARDS SAFE TO USE IN PATIENTS WITH RENAL IMPAIRMENT?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 560.1-560
Author(s):  
F. Rees ◽  
M. Jasim
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Safety Profile ◽  
Ckd Stage ◽  
Synthetic Dmards ◽  
Renal Safety

Background:Chronic kidney disease (CKD) is defined as a permanent (minimum three month) reduction in glomerular filtration rate. [1] 10-30% of rheumatoid arthritis (RA) patients have CKD, compared to 5% of the general population.[1] There are several causes of CKD associated with RA including persistent inflammation, cardiovascular risk factors, frequent use of non-steroidal anti-inflammatory drugs and amyloidosis.[1] CKD in RA patients is associated with increased mortality.[2]The use of biologic and targeted synthetic DMARDs for treating RA has increased significantly in recent years. Studies have shown these therapies might reduce the risk of developing CKD in RA. [3] However, conversely, biologics have been linked to the development of glomerulonephritis.[4]Surprisingly few studies have explored the use of biologics in patients with pre-existing renal disease and whether they contribute to renal impairment themselves.Objectives:Our objectives were to explore the renal safety profile of biologic and targeted synthetic DMARDs in a real-world cohort of RA patients with and without pre-existing CKD.Methods:A retrospective observational study was completed using the Biologic Therapy Database at Cannock Chase Hospital. Inclusion criteria were a diagnosis of RA and current treatment with a biologic or targeted synthetic DMARD.Demographic data, renal function at biologic initiation and any deterioration of renal function were among the recorded information for each patient. Patients with insufficient information available via electronic patient records were excluded.Results:998 RA patients on biologics were identified, of whom 213 were excluded. Of the 785 remaining patients, a 3:1 female to male ratio was noted with a mean age of 62. 40% of patients were on an anti-TNF, 22% rituximab, 15% abatacept, 15% JAK inhibitors and 9% anti-IL6 respectively. At biologic initiation 92% of the patients had a GFR of >60 ml/min per 1.73m2, 4.8% had a GFR of 30-60 (CKD stage 3a-3b), <1% stage 4 CKD. No patients in the cohort had CKD stage 5 at biologic initiation.Overall, 13 patients had significant pre-existing CKD (eGFR <45) of these, 6 were treated with abatacept. 7/13 patients had no co-morbid risk factors for CKD – of those remaining, 2 were hypertensive, 2 diabetic and 2 both. None of these 13 patients experienced a drop in renal function by more than 1 stage since initiation of current biologic.Of those patients without prior CKD at the point of biologic initiation (GFR >45), only 15 patients (2%) developed new renal impairment whilst on biologic treatment. 10 patients’ renal function dropped by one stage and five patients by two stages. Crucially, 12 of the 15 patients were aged ≥75yrs and 10 patients had at least one other associated risk factor (e.g. diabetes). Only one patient in the cohort developed renal impairment as a direct result of a biologic - minimal-change disease secondary to etanercept.Conclusion:Our findings indicate that biologic treatments have a good renal safety profile – even with pre-existing CKD. RA patients most at risk of developing CKD whilst on biologics are likely to have other risk factors such as diabetes or hypertension. As previously stated, there is a very rare association of anti-TNF biologics causing glomerulonephritis.References:[1]Couderc M, et al. Prevalence of Renal Impairment in Patients with Rheumatoid Arthritis: Results from a Cross-Sectional Multicenter Study. Arthritis Care Res. 2016 May 1;68(5):638–44.[2]Chiu HY, et al. Increased risk of chronic kidney disease in rheumatoid arthritis associated with cardiovascular complications - A national population-based cohort study. PLoS One. 2015 Sep 25;10(9).[3]Sumida K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018 May 1;93(5):1207–16.[4]Piga M, et al. Biologics-induced autoimmune renal disorders in chronic inflammatory rheumatic diseases: Systematic literature review and analysis of a monocentric cohort. Vol. 13, Autoimmunity Reviews. Elsevier; 2014. p. 873–9.Disclosure of Interests:None declared

scholarly journals Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry

2019 ◽  
Vol 9 (1) ◽  
pp. 4
Author(s):  
Emmanuelle Vidal-Petiot ◽  
Nicola Greenlaw ◽  
Paul R. Kalra ◽  
Xavier Garcia-Moll ◽  
Jean-Claude Tardif ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Stable Coronary Artery Disease ◽  
Ckd Stage ◽  
Artery Disease

Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower—although overall high—rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m2) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0.81–1.18), 1.31 (1.05–1.63), 1.77 (1.38–2.27), and 3.12 (2.25–4.33) for eGFR 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2, compared with eGFR ≥90 mL/min/1.73 m2. A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.

scholarly journals SAT0483 SAFETY OF INTRAVENOUS IBANDRONIC ACID IN CHRONIC KIDNEY DISEASE: A REAL WORLD EXPERIENCE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1198.3-1198
Author(s):  
J. Southern ◽  
M. Chakravorty ◽  
L. H. Lee
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Renal Function ◽  
Zoledronic Acid ◽  
Kidney Disease ◽  
Real World ◽  
Safety Profile ◽  
Ibandronic Acid ◽  
Vitamin D Levels ◽  
Ckd Stage

Background:Common forms of intravenous bisphosphonate used at the Royal Derby Hospital are zoledronic acid and ibandronic acid for a variety of indications. In the treatment of osteoporosis, zoledronic acid is preferred due to its convenience of once-yearly dosing; compared to ibandronic acid which is given three-monthly. Zoledronic acid is contraindicated in patients with an estimated glomerular filtration rate (eGFR) of less than 35 due to nephrotoxicity concerns. Ibandronic acid, however, is generally offered with an eGFR of 30 or over and is perceived to be a safer choice in more advanced chronic kidney disease. The potential of extending the use of ibandronic acid to patients with lower eGFR is being explored. However, there is a paucity of real world data and this study will therefore seek to affirm the safety profile in those on treatment.Objectives:Establish the safety profile of IV ibandronic acid with regards to worsening renal function or significant hypocalcaemia injury in the context of reduced renal clearance.Methods:The details of patients receiving IV ibandronic acid at Royal Derby Hospital were retrieved from the osteoporosis department register in September 2019. Data was collected anonymously from records using the electronic prescribing and pathology hospital database, together with electronic letters. The first three pre-infusion serum adjusted calcium levels, vitamin D, creatinine and eGFR were recorded. In addition, results from initiation to present were screened for any episodes of hypocalcaemia, acute kidney injury (AKI) or significant decline in renal function.Results:Treatment duration ranged from 6 months to 6 years. Female:male ratio was 9:1 and the average age was 75 years (range 50-90). Baseline eGFR ranged from 27 to over 60; 3 patients had eGFR≥60, 2 had eGFR 27 while remaining patients (75%) had eGFR 30-59. All patients received a standard 3mg infusion on each occasion. The most common rationale cited for ibandronic acid choice as opposed to zoledonic acid was reduced creatinine clearance or eGFR. Three patients (15%) developed one or more episodes of mild hypocalcaemia (lowest 2.01 mmol/l). No episodes of hypocalcaemia were identified in the first three pre-infusion levels. Four patients (25%) had a decline in eGFR by more than 5 ml/min/1.73m2but there was no definitive causal link with ibandronic acid and was most commonly felt to be related to their underlying renal disease. Three patients (15%) had at least one episode of AKI since commencing treatment, each explained by an intercurrent illness. Serum Vitamin D levels were measured pre-infusion in 92% of cases.Conclusion:This study reaffirms the safety profile of ibandronic acid use in renal function as low as CKD Stage 3b (≥30ml/min/1.73m2). No episodes of AKI or sustained decline in renal function were causally linked to ibandronic acid.References:Royal Derby Hospital Proposed Clinical Guideline (2019) – Use of ibandronic acid in CKD 4 at reduced dosage.Disclosure of Interests:None declared

scholarly journals P0949EFFECT OF DIETARY PHOSPHORUS RESTRICTION ON FIBROBLAST GROWTH FACTOR,KLOTHO AND BODY COMPOSITION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Trisha Sachan ◽  
Anita Saxena ◽  
Amit Gupta
Keyword(s):  
Chronic Kidney Disease ◽  
Body Composition ◽  
Renal Function ◽  
Kidney Disease ◽  
Urinary Protein ◽  
Dietary Phosphorus ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
Fgf 23

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p&lt;0.001), s albumin (p&lt;0.001), FGF-23 (p&lt;0.001), klotho (p&lt;0.001), urinary protein (p&lt;0.001) and Nephron Index (p&lt;0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p&lt;0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p&lt;0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p&lt;0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.

MO515CONSTIPATION IN CHRONIC KIDNEY DISEASE: PREVALENCE AND RISK FACTORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sourabh Sharma ◽  
Neha Sharma ◽  
Kailash Sharma
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
Functional Constipation ◽  
Common Symptom ◽  
Psychological Burden ◽  
Ckd Stage ◽  
Stool Form ◽  
Rome Iv

Abstract Background and Aims Among various gastrointestinal disorders, constipation is one of the most common symptom in chronic kidney disease (CKD). However it is often neglected by nephrologists as self-limiting condition. Constipation impacts quality of life in multiple ways and increases socio-psychological burden. Constipation and associated risk factors have been poorly studied and most studies are retrospective. Method We enrolled CKD stage 3 to 5 patients on regular follow-up with nephrologist from June 2018 to June 2020, at a tertiary care centre in North India. Constipation was defined using Rome IV criteria (Functional constipation) which is composed of six constipation related symptoms, and diagnosis of constipation is established by presence of two or more symptoms for at least 3 months. Patients were also asked to maintain a 7 day prospective stool diary. It consisted of seven day written prospective chart of stool form and frequency. Patients were instructed to record when each bowel movement happened and to mark stool form type for each movement as described in words and pictures on Bristol Stool Form Scale (BSFS). Opioid induced constipation was defined as per Rome IV criteria. The diagnostic criteria is similar to functional constipation, but with requisite that new or worsening symptoms occurred when initiating, changing or increasing opioid therapy. Results Two hundred twenty five patients were studied out of which 59 (26.2%) patients were in CKD stage3, eighty one (36%) patients were in CKD stage4 and 85 (37.8%) patients were in stage5. Out of 85 CKD stage5 patients, 23 (27%) were on dialysis. Mean age of patients was 49.1 years. Out of 225 patients, 135 (60%) were male. Constipation symptoms and diagnosis reported in each stage has been depicted in Table 1. Clinical correlates of constipation has been depicted in Table 2. Conclusion Constipation measured using Rome IV criteria affects around two-third of CKD stage 3-5 patients. Diabetes, hypertension and opioid use has been found to be significantly associated with constipation.

scholarly journals Beberapa Faktor Risiko Kejadian Penyakit Ginjal Kronik (PGK) Stadium V pada Kelompok Usia Kurang dari 50 Tahun (Studi di RSUD dr.H.Soewondo Kendal dan RSUD dr.Adhyatma,MPH Semarang)

2018 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Ariyanto Ariyanto ◽  
Suharyo Hadisaputro ◽  
Lestariningsih Lestariningsih ◽  
Mateus Sakundarno Adi
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Herbal Medicine ◽  
Energy Drink ◽  
Regression Result ◽  
Age Group ◽  
Case Control Studies ◽  
Ckd Stage ◽  
Energy Drink Consumption

Background: Chronic Kidney Disease (CKD) stage V is an end-stage chronic kidney disease  characterized by glomerular filtration rate less than 15 mL /min /1.73 m2 and require dialysis  therapy. The purpose of this study to prove risk factors the occurrence of CKD Vin the age  group of less than 50 years.   Method: This study was a mixed method, case-control studies design were inforced with  indepht interview. Total respondents were 124 (62 cases and 62 controls) that taken by  consecutive sampling. Research instrument was a questionnaire interview. Data analysis using  univariate, bivariate (chi-square) and multivariate (logistic regression).                     Result: The variables that proved to be a risk factor for CKD V in the age group of less than 50 years were supplement energy drink consumption > 4 times/week (p=0.038; 95%CI = 1.063-7.944; OR=2.905), smoking ≥ 10 ciggarets/day (p=0.011; 95%CI=1.384-11.920; OR=4.061), and herbal medicine consumption > 4 times/week (p=0.007; 95%CI=1.431-9.949; OR=3.773). Variables that not proved were the consumption of coffee, supplements of vitamin C, soft drinks, alcohol, and NSAIDs. Qualitative results stated that the respondents consumed energy drink supplements to increase their stamina, smoke because it has become a habit, and consume herbal medicines because seen more natural and cure the sciatica fastly.Conclusion: Risk factors for the occurrence of CKD V in the age group of less than 50 years were the supplement energy drink consumption> 4 times/week, smoking ≥ 10 ciggarets/day, and the consumption of herbal medicine> 4 times/week.

scholarly journals Beberapa Faktor Risiko Kejadian Penyakit Ginjal Kronik (PGK) Stadium V pada Kelompok Usia Kurang dari 50 Tahun (Studi di RSUD dr.H.Soewondo Kendal dan RSUD dr.Adhyatma,MPH Semarang)

2018 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Ariyanto Ariyanto ◽  
Suharyo Hadisaputro ◽  
Lestariningsih Lestariningsih ◽  
Mateus Sakundarno Adi
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Herbal Medicine ◽  
Energy Drink ◽  
Regression Result ◽  
Age Group ◽  
Case Control Studies ◽  
Ckd Stage ◽  
Energy Drink Consumption

Background: Chronic Kidney Disease (CKD) stage V is an end-stage chronic kidney disease  characterized by glomerular filtration rate less than 15 mL /min /1.73 m2 and require dialysis  therapy. The purpose of this study to prove risk factors the occurrence of CKD Vin the age  group of less than 50 years.   Method: This study was a mixed method, case-control studies design were inforced with  indepht interview. Total respondents were 124 (62 cases and 62 controls) that taken by  consecutive sampling. Research instrument was a questionnaire interview. Data analysis using  univariate, bivariate (chi-square) and multivariate (logistic regression).                     Result: The variables that proved to be a risk factor for CKD V in the age group of less than 50 years were supplement energy drink consumption > 4 times/week (p=0.038; 95%CI = 1.063-7.944; OR=2.905), smoking ≥ 10 ciggarets/day (p=0.011; 95%CI=1.384-11.920; OR=4.061), and herbal medicine consumption > 4 times/week (p=0.007; 95%CI=1.431-9.949; OR=3.773). Variables that not proved were the consumption of coffee, supplements of vitamin C, soft drinks, alcohol, and NSAIDs. Qualitative results stated that the respondents consumed energy drink supplements to increase their stamina, smoke because it has become a habit, and consume herbal medicines because seen more natural and cure the sciatica fastly.Conclusion: Risk factors for the occurrence of CKD V in the age group of less than 50 years were the supplement energy drink consumption> 4 times/week, smoking ≥ 10 ciggarets/day, and the consumption of herbal medicine> 4 times/week.

scholarly journals Effects of Renal Impairment and Hemodialysis on the Pharmacokinetics and Safety of the Glecaprevir and Pibrentasvir Combination in Hepatitis C Virus-Negative Subjects

2017 ◽  
Vol 62 (3) ◽  
Author(s):  
Matthew P. Kosloski ◽  
Weihan Zhao ◽  
Thomas C. Marbury ◽  
Richard A. Preston ◽  
Michael G. Collins ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Combined Treatment ◽  
Hcv Infection ◽  
Renal Elimination ◽  
Genotype 2

ABSTRACT Hepatitis C virus (HCV) infection is an independent risk factor for developing chronic renal impairment and end-stage renal disease. Limited treatment options are available for HCV genotype 2, 3, 5, and 6 infections in patients with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Glecaprevir and pibrentasvir are active against all six major HCV genotypes, are primarily excreted in the bile, and have minimal renal elimination. Therefore, combined treatment with these direct-acting antivirals may be useful for patients with HCV infection and chronic kidney disease. A phase 1, multicenter, open-label study evaluated the effects of renal impairment on the pharmacokinetics and safety of glecaprevir-pibrentasvir. In substudy 1, 38 subjects with stage 2 to 5 chronic kidney disease who were not on dialysis or who had normal renal function received single doses of the combination of 300 mg glecaprevir and 120 mg pibrentasvir. In substudy 2, 8 subjects requiring hemodialysis received single doses of the combination of 300 mg glecaprevir and 120 mg pibrentasvir under dialysis and nondialysis conditions. Regression analyses demonstrated increased glecaprevir and pibrentasvir plasma exposures, as determined by the area under the curve, with decreasing renal function, up to 56% and 46%, respectively, in subjects with an eGFR of <15 ml/min/1.73 m 2 . In dialysis-dependent subjects, glecaprevir and pibrentasvir exposures were similar (≤18% difference) when study drugs were administered before hemodialysis or on a nondialysis day. Adverse events were mostly mild, with the most common being self-limited fatigue (3 subjects). The study findings support the clinical evaluation of glecaprevir-pibrentasvir without dose adjustment in HCV-infected subjects with renal impairment. (This study has been registered at ClinicalTrials.gov under registration number NCT02442258.)

Risk of Stroke, Bleeding, and Death in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 178-186
Author(s):  
Yoav Arnson ◽  
Moshe Hoshen ◽  
Adi Berliner-Sendrey ◽  
Orna Reges ◽  
Ran Balicer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Bleeding Risk ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stroke Death

Introduction: Atrial fibrillation (AF) and chronic kidney disease (CKD) are both associated with increased risk of stroke, and CKD carries a higher bleeding risk. Oral anticoagulation (OAC) treatment is used to reduce the risk of stroke in patients with nonvalvular AF (NVAF); however, the risk versus benefit of OAC for advanced CKD is continuously debated. We aim to assess the management and outcomes of NVAF patients with impaired renal function within a population-based cohort. Methods: We conducted a retrospective observational cohort study using ICD-9 healthcare coding. Patients with incident NVAF between 2004 and 2015 were identified stratified by CKD stage. We compared treatment strategies and estimated risks of stroke, death, or any major bleeding based on CKD stages and OAC treatment. Results: We identified 85,116 patients with incident NVAF. Patients with impaired renal function were older and had more comorbidities. OAC was most common among stage 2 CKD patients (49%) and least in stages 4–5 CKD patients (27.6%). Higher CKD stages were associated with worse outcomes. Stroke rates increased from 1.04 events per 100 person-years (PY) in stage 1 CKD to 3.72 in stages 4–5 CKD. Mortality increased from 3.42 to 32.95 events/100 PY, and bleeding rates increased from 0.89 to 4.91 events/100 PY. OAC was associated with reduced stroke and intracranial bleeding risk regardless of CKD stage, and with a reduced mortality risk in stages 1–3 CKD. Conclusion: Among NVAF patients, advanced renal failure is associated with higher risk of stroke, death, and bleeding. OAC was associated with reduced stroke and intracranial bleeding risk, and with improved survival in stages 1–3 CKD.

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