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Abstract

Background and Aims

Our population with advanced chronic kidney disease (ACKD), is more prone to thrombotic and hemorrhagic processes so the indication of anticoagulation before the appearance of atrial fibrillation (AF) is complex. Since AF is the most common cardiac arrhythmia, its main complications are thromboembolism and stroke. New treatments are being developed, such as the new oral anticoagulants (NOAs), but their safety in ACKD is still uncertain.

To see anticoagulation needs, safety and major adverse effects (major or minor bleeding) in population with ACKD and taking dicumarinics or NOAs.

Method

Retrospective study of 234 patients followed in our ACKD practice, at least two revisions, with a mean follow-up 25.5 months, in which we recorded cause of anticoagulation, type and major adverse effects.

Results

26% of patients have indication for anticoagulation (66 patients), of which 55 remain anticoagulated during follow-up (45% Dicumarinics, 44% NOAs). The indication for anticoagulation was 23% AF (56 patients) and 3% mechanical prostheses (7 patients). Table 1 shows the characteristics of the overall population and the comparison between anticoagulated patients with different types of anticoagulation and non-anticoagulated patients. Non-anticoagulated patients are younger and have less ischemic heart disease, with no differences in the non-anticoagulated population. Throughout follow-up, we found a higher incidence of bleeding with NOAs (compared to the rest) and higher mortality in patients with dicumarinics (compared to the rest). There were no differences in age, sex and ischemic heart disease between the two anticoagulant treatments.

Conclusion

Our CKD population has a high need for anticoagulation but also a high risk of bleeding. NOAs can be used in ACKD although they are associated with a higher incidence of bleeding than dicumarinics but lower mortality. More studies are needed to conclude which is the best approach for these patients.

Total: (N 234)Dicumarinic (N 31)NOAs (N 24)No anticoagulation (N 179)
Age76.3 (±13.8)80.8±6.981.5±9.175.1±14*
Gender (%) Men62.4%45.262.565.4
DM (%)39.3%41.945.838%
Cardiopathy ischemic (%).20.1%32.333.316.2*
GF (ml/min)19.3 (±5.6)20.6±4.820.7±5.818.9±5.6
Time25.5 (±17.5)26.6±20.223.9±15.525.4±17
Bleeding (L/G)4.7% / 12%6.3% / 12.5%17.4% / 21.3 ***2.8% /10.6%
Death26.1%45.2**2522.9%
Total: (N 234)Dicumarinic (N 31)NOAs (N 24)No anticoagulation (N 179)
Age76.3 (±13.8)80.8±6.981.5±9.175.1±14*
Gender (%) Men62.4%45.262.565.4
DM (%)39.3%41.945.838%
Cardiopathy ischemic (%).20.1%32.333.316.2*
GF (ml/min)19.3 (±5.6)20.6±4.820.7±5.818.9±5.6
Time25.5 (±17.5)26.6±20.223.9±15.525.4±17
Bleeding (L/G)4.7% / 12%6.3% / 12.5%17.4% / 21.3 ***2.8% /10.6%
Death26.1%45.2**2522.9%

***P < 0.05 NOAs VS Rest, **P < 0.05 Dicumarinics VS Rest, *P < 0.05 no Anticoagulation VS Rest.

Total: (N 234)Dicumarinic (N 31)NOAs (N 24)No anticoagulation (N 179)
Age76.3 (±13.8)80.8±6.981.5±9.175.1±14*
Gender (%) Men62.4%45.262.565.4
DM (%)39.3%41.945.838%
Cardiopathy ischemic (%).20.1%32.333.316.2*
GF (ml/min)19.3 (±5.6)20.6±4.820.7±5.818.9±5.6
Time25.5 (±17.5)26.6±20.223.9±15.525.4±17
Bleeding (L/G)4.7% / 12%6.3% / 12.5%17.4% / 21.3 ***2.8% /10.6%
Death26.1%45.2**2522.9%
Total: (N 234)Dicumarinic (N 31)NOAs (N 24)No anticoagulation (N 179)
Age76.3 (±13.8)80.8±6.981.5±9.175.1±14*
Gender (%) Men62.4%45.262.565.4
DM (%)39.3%41.945.838%
Cardiopathy ischemic (%).20.1%32.333.316.2*
GF (ml/min)19.3 (±5.6)20.6±4.820.7±5.818.9±5.6
Time25.5 (±17.5)26.6±20.223.9±15.525.4±17
Bleeding (L/G)4.7% / 12%6.3% / 12.5%17.4% / 21.3 ***2.8% /10.6%
Death26.1%45.2**2522.9%

***P < 0.05 NOAs VS Rest, **P < 0.05 Dicumarinics VS Rest, *P < 0.05 no Anticoagulation VS Rest.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://dbpia.nl.go.kr/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Topic:
Issue Section:
C4 - CO-MORBIDITIES (ANAEMIA, CARDIOVASCULAR, CKD-MBD, ETC.)
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