Incidence of severe renal dysfunction among individuals taking warfarin and implications for non-vitamin K oral anticoagulants.
Incidence of severe renal dysfunction among individuals taking warfarin and implications for non-vitamin K oral anticoagulants.
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DOI：
10.1016/j.ahj.2016.08.017
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发表时间：
2017-03
影响因子：
4.8
通讯作者：
Hylek EM
中科院分区：
文献类型：
--
作者：
Fanola CL;Mooney D;Cowan AJ;Ko D;Sisson EK;Henault LE;Tripodis Y;Hylek EM
本研究的目的是评估需要口服抗凝的患者严重肾功能障碍的发生率和危险因素，以帮助指导最初的药物选择，并为非维生素K口服抗凝剂患者的肾功能间歇监测提供合理的依据。自2007年1月至2010年12月连续入选接受华法林治疗的心房颤动或静脉血栓栓塞症患者。评估基线肾功能，并跟踪患者的第一次肾功能下降至内生肌酐清除量和30毫升/分钟。多元回归评估了影响主要结果的独立危险因素。通过Kaplan-Meier分析评估以基线肾功能为基础的严重肾损害。在确诊的787名患者中，34名排除了基线CrCl30毫升/分钟。平均年龄71岁，高血压和糖尿病分别占74%和31%。基线时，23%(n=174)的患者患有中度慢性肾脏病(CKD)(CrCl30-59mL/min)，而31%的患者患有轻度CKD(CrCl60-89mL/min)。发生严重肾损害92例(12%)，其中25%发生在5.3个月内。在基线3期CKD患者中，37%发展为严重的肾损害。3期CKD患者发生严重肾功能障碍的风险增加14倍(优势比14.5，95%可信区间6.7-31.3，P<；.001)。冠状动脉疾病也与严重的肾损害相关(优势比2.2，95%可信区间1.3-3.8，P=0.004)。急性和慢性肾功能障碍在需要长期抗凝治疗的患者中很常见。患有中度慢性肾脏疾病和冠状动脉疾病的患者发生严重肾损害的短期风险最高。有必要对这些患者进行更频繁的监测。
The purpose of this study is to assess incidence and risk factors for severe renal dysfunction in patients requiring oral anticoagulation to help guide initial drug choice and provide a rational basis for interval monitoring of renal function for patients prescribed non–vitamin K oral anticoagulants. Patients on warfarin for atrial fibrillation or venous thromboembolism were consecutively enrolled from January 2007 to December 2010. Baseline kidney function was assessed, and patients were followed to their first decline of kidney function to creatinine clearance <30 mL/min. Multivariate regression assessed independent risk factors for the primary outcome. Severe renal impairment based on baseline kidney function was assessed by Kaplan-Meier analyses. Of 787 patients identified, 34 were excluded for baseline CrCl <30 mL/min. The mean age was 71 years, and 74% and 31% had hypertension and diabetes mellitus, respectively. At baseline, 23% (n = 174) had moderate chronic kidney disease (CKD) (CrCl 30–59 mL/min), whereas 31% had mild CKD (CrCl 60–89 mL/min). Severe renal impairment occurred in 92 patients (12%), 25% of which was seen within 5.3 months. Of those with baseline stage 3 CKD, 37% developed severe renal impairment. Stage 3 CKD conferred a 14-fold increased risk in the development of severe renal dysfunction (odds ratio 14.5, 95%CI 6.7–31.3, P < .001). Coronary artery disease was also associated with severe renal impairment (odds ratio 2.2, 95% CI 1.3–3.8, P = .004). Acute and chronic renal dysfunction is common among individuals requiring long-term anticoagulant therapy. Patients with moderate chronic kidney disease and coronary artery disease are at the highest short-term risk of developing severe renal impairment. More frequent monitoring of these patients is warranted.
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