Renal Function Outcomes in Atrial Fibrillation With Oral Anticoagulation Therapy

Patients with atrial fibrillation who are treated with oral anticoagulants often experience renal function decline.

Renal function decline is common in patients with atrial fibrillation (AF) who are treated with oral anticoagulants (OACs), according to study findings published in the Journal of the American College of Cardiology.

Investigators compared nonvitamin K antagonist OACs (NOACs) apixaban, dabigatran, rivaroxaban, and warfarin to determine their effect on acute kidney injury, kidney failure, doubling patients’ serum creatinine level, and reducing estimated glomerular filtration rate (eGFR) by at least 30%. Patients with nonvalvular AF (n=9769) who were taking an anticoagulant agent were identified using a national administrative database.


Participants taking any oral anticoagulant had a higher cumulative risk for at least a 30% decline in eGFR at the end of 2 years compared with AKI, kidney failure, or doubling of serum creatinine (24.4% vs 14.8%, 1.7%, and 4.0%, respectively).

Researchers pooled outcomes data of the NOACs and found that they were associated with a lower risk for at least a 30% decline in eGFR (hazard ratio [HR], 0.77; 95% CI, 0.66-0.89; P <.001), AKI (HR, 0.68; 95% CI, 0.58-0.81; P <.001), and doubling of serum creatinine (HR, 0.62; 95% CI, 0.40-0.95; P =.03) when compared with warfarin. The investigators were unable to find any significant associations between apixaban and a lower risk for adverse renal outcomes.

One limitation of this study was its relatively short follow-up period of 10.7±9.9 months. In addition, the investigators were unable to identify kidney failure differences among the medication groups because of the small number of adverse events in the patient population.

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The observation that renal function decline represents a common occurrence in AF patients managed with OACs “underscores the need for periodic monitoring and comprehensive efforts to prevent and treat progressive [chronic kidney disease].”


Yao X, Tangri N, Gersh BJ, et al. Renal outcomes in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol. 2017;70(21):2621-2632.