Whether Warfarin Therapy is Associated with Damage on Renal Function in Chinese Patients with Nonvalvular Atrial Fibrillation

• Published in: Chinese medical journal Vol. 129; no. 10; pp. 1135 - 1139
• Main Authors: Kong, Yu, Du, Xin, Tang, Ri-Bo, Zhang, Ting, Guo, Xue-Yuan, Wu, Jia-Hui, Xia, Shi-Jun, Ma, Chang-Sheng
• Format: Journal Article
• Language: English
• Published: China Wolters Kluwer - Medknow Publications 20.05.2016; Lippincott Williams & Wilkins Ovid Technologies; Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Aged; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Anticoagulation; Estimated Glomerular Filtration Rate; Nonvalvular Atrial Fibrillation; Renal Function; Warfarin; Atrial Fibrillation - drug therapy; Atrial Fibrillation - physiopathology; Cardiac arrhythmia; eGFR; Female; Glomerular Filtration Rate - physiology; Humans; Kaplan-Meier Estimate; Kidney - drug effects; Male; Middle Aged; Mortality; Original; Prospective Studies; Rodents; Stroke; Warfarin - adverse effects; Warfarin - therapeutic use; 中国; 患者; 抗凝; 治疗; 肾功能不全; 肾功能损害; 膜; Warfarin; Anticoagulation; Estimated Glomerular Filtration Rate; Nonvalvular Atrial Fibrillation; Renal Function
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.181970

Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.