Effect of rivaroxaban on urinary albumin excretion in patients with atrial fibrillation and chronic kidney disease: a randomized trial (X-NOAC)

Tanaka, Atsushi; Matsunaga, Kazuo; Tanaka, Isao; Chihara, Atsuko; Oyama, Jun‐ichi; Node, Koichi

doi:10.1038/s41440-019-0384-6

Cited by 3 publications

(3 citation statements)

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“…[ 37 ] In a randomised trial involving patients with chronic kidney disease, rivaroxaban (compared with warfarin) reduced urinary albumin excretion and attenuated tubular injury in individuals with AF and micro-/ macroalbuminuria chronic kidney disease. [ 38 ]…”

Section: Discussionmentioning

confidence: 99%

“…37 In a randomised trial involving patients with chronic kidney disease, rivaroxaban (compared with warfarin) reduced urinary albumin excretion and attenuated tubular injury in individuals with AF and micro-/ macroalbuminuria chronic kidney disease. 38 The primary limitation of our meta-analysis is the high heterogeneity among studies. The high heterogeneity in outcomes, specifically for AKI, a ≥30% decrease in eGFR and worsening renal function, warrants a multifaceted exploration of potential underlying factors.…”

Section: (B-e) Subgroup Analysis: Patients With Diabetes (B) Patients...mentioning

confidence: 99%

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Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence

Dinh,

Ho,

Pham

et al. 2024

Eur Cardiol

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Background: AF is a global health concern, with systemic complications including renal dysfunction. This systematic review and meta-analysis compares the effects of rivaroxaban, a Factor Xa inhibitor, and vitamin K antagonists (VKAs) on renal outcomes in AF patients. Methods: The study protocol is registered in PROSPERO (ID: CRD42023462756). We systematically searched the PubMed, Embase and Cochrane Library databases from 1 January 2017 to 30 June 2023 for real-world studies comparing the effects of rivaroxaban and VKAs on renal outcomes in AF patients, including acute kidney injury, a ≥30% decrease in estimated glomerular filtration rate, doubling of serum creatinine and worsening renal function. Subgroup analyses targeted diabetes, pre-existing kidney disease, the elderly (age ≥65 years) and Asian populations. The risk of bias was assessed used the Robins-I tool. HRs and 95% CIs were synthesised through a random-effects model. Two sensitivity analyses were performed, using a fixed-effects model and excluding conference abstracts. Results: We identified 1,666 records. After screening, 14 studies comparing rivaroxaban and VKAs were included. Rivaroxaban exhibited superiority over VKAs in preventing: acute kidney injury (HR 0.68; 95% CI [0.61–0.77]; p<0.00001); a ≥30% decrease in estimated glomerular filtration rate (HR 0.71; 95% CI [0.60–0.84]; p<0.0001); doubling of serum creatinine (HR 0.50; 95% CI [0.36–0.70]; p<0.0001); and worsening renal function (HR 0.56; 95% CI [0.45–0.69]; p<0.00001). Subgroup and sensitivity analyses consistently confirmed rivaroxaban’s favourable effects on renal outcomes in diabetes, pre-existing kidney disease, the elderly and Asian populations. Conclusion: Our findings support the preference of rivaroxaban over VKAs for renal outcomes in AF. The findings endorse rivaroxaban as the preferred anticoagulant to mitigate renal complications, offering clinicians valuable insights for tailored strategies.

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Section: Discussionmentioning

confidence: 99%

Section: (B-e) Subgroup Analysis: Patients With Diabetes (B) Patients...mentioning

confidence: 99%

Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence

Dinh,

Ho,

Pham

et al. 2024

Eur Cardiol

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“…Следует отметить, что в США дабигатран может применяться в дозе 75 мг 2 раза/сут., определенной на основе фармакокинетического моделирования и не изученной в РКИ, что может объяснять имеющиеся различия с данными, полученными в других странах. По данным открытого рандомизированного исследования с небольшим количеством участников (n=51), страдавших ФП и ХБП С2-С3b стадий, ривароксабан в дозе 15 (10) мг не оказывал влияния на степень альбуминурии по сравнению с варфарином в течение трех месяцев, а в других работах выраженность экскреции белка с мочой на фоне терапии ППОАК не изучалась [66].…”

Section: исследования реальной клинической практикиunclassified

New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction

2020

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Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and interrelated diseases, the combination of which is associated with a poor prognosis. The efficacy and safety of direct oral anticoagulants (DOACs) used to prevent thromboembolic complications of AF may depend on renal function due to the specific pharmacokinetics of these drugs. This review considers current data on the role of kidneys in the pathogenesis of ischemic and bleeding events, methods of renal function assessment and related classification issues, as well as comparison of warfarin and DOAC therapy, in patients with AF and renal dysfunction of different stages based on the results of randomized controlled trials and actual clinical practice. DOAC use in the context of dynamic deterioration of renal function, supranormal renal function, and their effect on renal outcomes is discussed. International guidelines on anticoagulant therapy in AF and renal dysfunction were analyzed.

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Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease—a systematic review and meta-analysis

Calderon Martinez,

Sanchez Cruz,

Diarte Acosta

et al. 2024

J Nephrol

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Background Chronic Kidney Disease (CKD) significantly increases the risk of cardiovascular diseases, including atrial fibrillation, which usually requires anticoagulant therapy. The effectiveness and safety of direct oral anticoagulants compared to vitamin K antagonists in patients with CKD remain insufficiently studied, particularly in the more advanced stages. Methods This systematic review, registered in PROSPERO (CRD42023410192), adhered to PRISMA guidelines and included randomized clinical trials and cohort studies comparing direct oral anticoagulants and vitamin K antagonists in CKD patients. Major databases were searched, and studies were selected based on strict inclusion criteria. A meta-analysis was performed using random-effects models. Results Twenty-three studies with a total of 465,673 CKD patients were included. Direct oral anticoagulants showed a significant reduction in major bleeding events compared to vitamin K antagonists (Relative Risk [RR] = 0.62, 95% Confidence Interval: 0.49–0.79, p < 0.01) and a non-significant trend toward reducing thromboembolic events (RR = 0.69, 95% Confidence Interval: 0.43–1.14, p = 0.11). Furthermore, direct oral anticoagulants were associated with a significant reduction in all-cause mortality (RR = 0.63, 95% Confidence Interval: 0.43–0.91, p = 0.02). Conclusion Direct oral anticoagulants may offer a safe alternative to vitamin K antagonists in CKD patients, particularly in terms of reducing bleeding risks and potentially improving survival. However, their role in preventing thromboembolic events remains uncertain, highlighting the need for further research, especially in patients with advanced CKD and kidney failure. Graphical abstract

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Effect of rivaroxaban on urinary albumin excretion in patients with atrial fibrillation and chronic kidney disease: a randomized trial (X-NOAC)

Cited by 3 publications

References 10 publications

Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence

Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence

New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction

Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease—a systematic review and meta-analysis

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