The Role of Direct Oral Anticoagulants in Advanced Chronic Kidney Disease – Questions and Future directions

Introduction. Warfarin remains the preferred oral anticoagulant for the treatment of venous thromboembolism (VTE) in patients with advanced chronic kidney disease (CKD). Although the direct oral anticoagulants (DOACs) have become preferred for treatment of VTE in the general population, patients with advanced CKD were excluded from the landmark trials. Postmarketing, safety data have demonstrated oral factor Xa inhibitors (OFXais) such as apixaban and rivaroxaban to be alternatives to warfarin for the prevention of stroke and systemic embolism in patients with atrial fibrillation. However, it remains unknown if these safety data can be extrapolated to the treatment of VTE and CKD. Methods. A retrospective cohort study from January 2013 to October 2019 was performed at NYU Langone Health. All adult patients with CKD stage 4 or greater, treated with anticoagulation for VTE, were screened. The primary outcome was tolerability of anticoagulant therapy at 3 months, defined as a composite of bleeding, thromboembolic events, and/or discontinuation rates. The secondary outcomes included bleeding, discontinuations, and recurrent thromboembolism. Results. There were 56 patients evaluated, of which 39 (70%) received warfarin and 17 (30%) received an OFXai (apixaban or rivaroxaban). Tolerability at 3 months was assessed in 48/56 patients (86%). A total of 34/48 (71%) patients tolerated anticoagulation at 3 months, 12 (80%) in the OFXai arm, and 22 (67%) in the warfarin arm ( p = 0.498 ). There were 10/48 (21%) patients that experienced any bleeding events within 3 months, 7 on warfarin, and 3 on apixaban. Recurrence of thromboembolism within 3 months occurred in 3 patients on warfarin, with no recurrence in the OFXai arm. Discussion. OFXais were better tolerated compared to warfarin for the treatment of VTE in CKD, with lower rates of bleeding, discontinuations, and recurrent thromboembolism in a small cohort. Future prospective studies are necessary to confirm these findings.

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Direct oral anticoagulants in adults with congenital heart disease – Role of chronic kidney disease

International Journal of Cardiology ◽

10.1016/j.ijcard.2019.12.056 ◽

2020 ◽

Vol 302 ◽

pp. 45

Author(s):

Claudia Pujol ◽

Mara Müssigmann ◽

Peter Ewert ◽

Oktay Tutarel

Keyword(s):

Chronic Kidney Disease ◽

Congenital Heart Disease ◽

Heart Disease ◽

Kidney Disease ◽

Congenital Heart ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants

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Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in Cardiology Departments

Kardiologiia ◽

10.18087/cardio.2020.2.n823 ◽

2020 ◽

Vol 60 (2) ◽

pp. 41-46 ◽

Cited By ~ 1

Author(s):

M. I. Chashkina ◽

N. L. Kozlovskaya ◽

D. A. Andreev ◽

N. A. Ananicheva ◽

A. A. Bykova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Filtration Rate ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Newly Diagnosed ◽

Nonvalvular Atrial Fibrillation ◽

Advanced Chronic Kidney Disease ◽

Sustained Reduction

Objective. To estimate the prevalence of chronic kidney disease (CKD) 3b – 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy.Materials and Methods. Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b – 5 st and newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected.Results. Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 – warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 – apixaban 10 mg / day (16.2 %).Conclusion. A quarter of patients with AF revealed a decreased GFR <45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml / min / 1.72 m2 were prescribed DOACs, 27 % – warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2.

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Endocrine contribution to the sexual dysfunction in patients with advanced chronic kidney disease and the role of hyperprolactinemia

Andrologia ◽

10.1111/and.14135 ◽

2021 ◽

Author(s):

Haitham Elbardisi ◽

Ahmad Majzoub ◽

Christiana Daniel ◽

Fadwa Al.Ali ◽

Mohamed Elesnawi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Sexual Dysfunction ◽

Kidney Disease ◽

Advanced Chronic Kidney Disease

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How do direct oral anticoagulants compare with warfarin for preventing stroke and systemic embolic events in adults with atrial fibrillation and chronic kidney disease?

Cochrane Clinical Answers ◽

10.1002/cca.2014 ◽

2018 ◽

Author(s):

Jane Burch ◽

Juliana Ester Martin-Lopez

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants

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Hematologic Abnormalities in Chronic Kidney Disease

10.2310/nephro.1370 ◽

2018 ◽

Author(s):

Michael Auerbach ◽

John Anderson ◽

Khalid Al Talib

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Oral Anticoagulants ◽

Infusion Reaction ◽

Nonvalvular Atrial Fibrillation ◽

Novel Oral Anticoagulant ◽

Before And After ◽

Iv Iron ◽

A Minor

The focus of this review is on information practical to the practicing nephrologist and internists managing patients with chronic kidney disease (CKD), with an emphasis on the quantitative aspects of risk, diagnosis, treatment, and prognosis. Consequently, anemia associated with non–dialysis-associated CKD is emphasized, with special attention to the role of erythropoiesis-stimulating agents and intravenous (IV) iron in treating the anemia of CKD, as well as sections on uremic bleeding and anticoagulation in CKD patients. Figures show a patient before and after a minor infusion reaction, an algorithm outlining grading and management of acute hypersensitivity reactions to IV iron infusions, and an algorithm for the management of uremic platelet dysfunction. Tables list Food and Drug Administration-recommended dose adjustments for novel oral anticoagulant (NOACs) in CKD patients, evidence for preprocedural withholding of NOACs, and management guidelines for anticoagulation in nonvalvular atrial fibrillation and venous thromboembolism. This review contains 2 highly rendered figures, 3 tables, and 101 references. Key words: Chronic kidney disease; CKD; Anemia of chronic kidney disease; Anemia of CKD; Uremic bleeding; Anticoagulation in CKD; Novel oral anticoagulants in CKD; NOAC CKD

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Phosphorylation of key podocyte proteins and the association with proteinuric kidney disease

AJP Renal Physiology ◽

10.1152/ajprenal.00002.2020 ◽

2020 ◽

Vol 319 (2) ◽

pp. F284-F291 ◽

Cited By ~ 1

Author(s):

Di Feng

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Human Kidney ◽

Future Directions ◽

Genetic Studies ◽

New Therapies ◽

Podocyte Proteins

Podocyte dysfunction contributes to proteinuric chronic kidney disease. A number of key proteins are essential for podocyte function, including nephrin, podocin, CD2-associated protein (CD2AP), synaptopodin, and α-actinin-4 (ACTN4). Although most of these proteins were first identified through genetic studies associated with human kidney disease, subsequent studies have identified phosphorylation of these proteins as an important posttranslational event that regulates their function. In this review, a brief overview of the function of these key podocyte proteins is provided. Second, the role of phosphorylation in regulating the function of these proteins is described. Third, the association between these phosphorylation pathways and kidney disease is reviewed. Finally, challenges and future directions in studying phosphorylation are discussed. Better characterization of these phosphorylation pathways and others yet to be discovered holds promise for translating this knowledge into new therapies for patients with proteinuric chronic kidney disease.

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