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Kidney function monitoring and nonvitamin K oral anticoagulant dosage in atrial fibrillation
Author(s) -
Andreu Cayuelas Jose Manuel,
Caro Martínez Cesar,
Flores Blanco Pedro Jose,
Elvira Ruiz Gines,
Albendin Iglesias Helena,
Cerezo Manchado Juan Jose,
Bailen Lorenzo Jose Luis,
Januzzi James L.,
García Alberola Arcadio,
ManzanoFernández Sergio
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12907
Subject(s) - medicine , atrial fibrillation , renal function , retrospective cohort study , creatinine , intensive care medicine
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.