Kidney function monitoring and nonvitamin K oral anticoagulant dosage in atrial fibrillation
Por:
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 and Manzano-Fernández S
Publicada:
1 jun 2018
Resumen:
BackgroundClinical 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 methodsThis 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.
ResultsDuring the follow-up (334 89 days), the compliance with kidney
function monitoring recommendations was 61% (n = 425). After
multivariate adjustment, age (OR x year: 0.92 (CI 95%: 0.89-0.95) P <
.001), creatinine clearance (OR x 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).
ConclusionsNoncompliance 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.
Filiaciones:
Andreu Cayuelas JM:
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
Caro Martínez C:
Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain
Flores Blanco PJ:
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Elvira Ruiz G:
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Albendin Iglesias H:
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Cerezo Manchado JJ:
Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
:
Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain
Januzzi JL:
Division of Cardiology, Massachusetts General Hospital, Boston, USA
García Alberola A:
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain
Manzano-Fernández S:
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain
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