Kidney function monitoring and nonvitamin K oral anticoagulant dosage in atrial fibrillation.


Journal Article

BACKGROUND: Clinical practice guidelines recommend regular kidney function monitoring in atrial fibrillation patients on nonvitamin K oral anticoagulants (NOAC); however, information regarding compliance with these recommendations in daily life conditions is scarce. We sought to determine the compliance with kidney function monitoring recommendations in nonvalvular atrial fibrillation (NVAF) patients starting NOAC and its implication on the appropriateness of NOAC dosage. MATERIAL AND METHODS: This study involves the retrospective analysis of a multicentre registry including consecutive NVAF patients who started NOAC (n = 692). Drug dosage changes and serum creatinine determinations were recorded during 1-year follow-up. European Heart Rhythm Association criteria were used to define the appropriateness of kidney function monitoring as well as adequate NOAC dosage. RESULTS: During the follow-up (334 ± 89 days), the compliance with kidney function monitoring recommendations was 61% (n = 425). After multivariate adjustment, age (OR × year: 0.92 (CI 95%: 0.89-0.95) P < .001), creatinine clearance (OR × mL/min: 1.02 (CI 95%: 1.01-1.03) P < .001) and adequate NOAC dosage at baseline (OR: 1.54 (CI 95%: 1.06-2.23), P = .024) were independent predictors of appropriate kidney function monitoring. Compliance with kidney function monitoring recommendations was independently associated with change to appropriate NOAC dose after 1 year (OR: 2.80 (CI 95%: 1.01-7.80), P = .049). CONCLUSIONS: Noncompliance with kidney function monitoring recommendations is common in NVAF patients starting NOAC, especially in elderly patients with kidney dysfunction. Compliance with kidney function monitoring recommendations was associated with adequate NOAC dosage at 1-year follow-up. Further studies are warranted to evaluate the implication of kidney function monitoring on prognosis.

Full Text

Duke Authors

Cited Authors

  • Andreu Cayuelas, JM; Caro Martínez, C; Flores Blanco, PJ; Elvira Ruiz, G; Albendin Iglesias, H; Cerezo Manchado, JJ; Bailen Lorenzo, JL; Januzzi, JL; García Alberola, A; Manzano-Fernández, S

Published Date

  • June 2018

Published In

Volume / Issue

  • 48 / 6

Start / End Page

  • e12907 -

PubMed ID

  • 29423910

Pubmed Central ID

  • 29423910

Electronic International Standard Serial Number (EISSN)

  • 1365-2362

Digital Object Identifier (DOI)

  • 10.1111/eci.12907


  • eng

Conference Location

  • England