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CC BY 4.0 · TH Open 2024; 08(01): e106-e113
DOI: 10.1055/s-0044-1780529
Original Article

Risk Profiles and Treatment Patterns in Atrial Fibrillation Patients with Chronic Kidney Disease Receiving or not Receiving Anticoagulation Therapy

Reinhold Kreutz 
1   Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, Berlin, Germany
,
Gilbert Deray
2   Department of Nephrology, Pitié-Salpêtrière Hospital, Paris 6 University, Paris, France
,
Jürgen Floege
3   Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
,
Marianne Gwechenberger
4   Division of Cardiology, University Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Kai Hahn
5   Nephrologische Praxis, Dortmund, Germany
,
Andreas R. Luft
6   Center for Neurology and Rehabilitation, Klinik für Neurologie, Universitätsspital Zürich, Switzerland and Cereneo, Vitznau, Switzerland
,
Pontus Persson
7   Institut für Vegetative Physiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
,
Christoph Axthelm
8   Cardiologicum Pirna and Dresden, Dresden, Germany
,
Juerg Hans Beer
9   Department Innere Medizin, Baden Switzerland and Center of Molecular Cardiology, Kantonsspital Baden, University of Zürich, Zürich, Switzerland
,
Jutta Bergler-Klein
4   Division of Cardiology, University Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Nicolas Lellouche
10   Service de Cardiologie 1, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
,
Jens Taggeselle
11   Praxis Dr. med. Jens Taggeselle, Markkleeberg, Germany
,
Jan Beyer-Westendorf
12   Thrombosis Research Unit, Division Haematology, Department of Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
› Author Affiliations Funding This work was funded by Bayer AG as an investigator-initiated study.
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Abstract

Background Patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are at high risk for both thromboembolism and bleeding events. The latter induces a potential reason for withholding oral anticoagulation (OAC) despite an indication for prophylaxis of thromboembolic events.

Methods AF patients with CKD (estimated glomerular filtration [eGFR] rate between 15 and 49 mL/min per 1.73 m2) were included in a prospective international registry in Europe between 2016 and 2020, that is, XARENO (factor XA inhibition in renal patients with nonvalvular atrial fibrillation observational registry). The study enrolled adult patients treated at the discretion of physicians with rivaroxaban, vitamin K antagonists (VKA), or without OAC (w/oOAC). Here, we report a prespecified explorative baseline comparison between patients receiving OAC or no OAC within XARENO.

Results In total, 1,544 patients (mean age: 78.2 years, mean eGFR: 36.2 mL/min) were studied (rivaroxaban n = 764, VKA n = 691, w/oOAC n = 89). Patients in the w/oOAC group were older and had a similar stroke (mean CHA2DS2-VASc score 4.0) but higher bleeding risk (mean modified Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly score 2.5 vs. 1.8) compared with the OAC groups. The distribution of comorbidities including hypertension, diabetes, and heart failure was similar. Treatment with antiplatelet drugs was fivefold more frequent in the w/oOAC group.

Conclusion Only 5.8% of the overall population of AF patients with advanced CKD received no OAC. These patients were older and had a higher bleeding risk, which might explain this decision, but which contrasts with the more frequent use of antiplatelet drugs in this vulnerable group of patients.

Keywords

atrial fibrillation - chronic kidney disease - anticoagulation - elderly - direct oral anticoagulants

Registration

The XARENO study is registered on URL: https://www.clinicaltrials.gov/; Unique identifier: NCT02663076.


Author Contributions

R.K. initiated the XARENO registry and is the principal investigator. He has written the first draft and finalized the manuscript. He coordinated the study overall.


G.D. is a member of the scientific steering committee of the XARENO and has contributed and approved the final draft of the manuscript.


J.F. is a member of the scientific steering committee of the XARENO and has contributed to and approved the final draft of the manuscript.


M.G. is a member of the scientific steering committee of the XARENO and has contributed to and approved the final draft of the manuscript.


K.H. is a member of the scientific steering committee of the XARENO and has contributed and approved the final draft of the manuscript.


A.L. is a member of the scientific steering committee of the XARENO and has contributed and approved the final draft of the manuscript.


P.P. is a member of the scientific steering committee of the XARENO and has contributed and approved the final draft of the manuscript.


C.A. has included many patients in the registry and contributed and approved the final draft of the manuscript.


J.H.B. has included many patients in the registry and contributed and approved the final draft of the manuscript.


J.B.-K. has included many patients in the registry and contributed and approved the final draft of the manuscript.


N.L. has included many patients in the registry and contributed and approved the final draft of the manuscript.


J.T. has included many patients in the registry and contributed and approved the final draft of the manuscript.


J.B.-W. is the co-principal investigator of the XARENO registry and has written the second draft and contributed to the final draft of the manuscript. He contributed to the overall coordination of the study.




Publication History

Received: 17 July 2023

Accepted: 21 December 2023

Article published online:
23 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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