Relationship between the Renal Function and Adverse Clinical Events in Patients with Atrial Fibrillation: A Japanese Multicenter Registry Substudy

Yuzawa, Yasuhumi; Kuronuma, Keiichiro; Okumura, Yasuo; Yokoyama, Kenichi; Matsumoto, Naoya; Tachibana, Eizo; Oiwa, Koji; Matsumoto, Michiaki; Kojima, Toshiaki; Haruta, Hironori; Nomoto, Kazumiki; Sonoda, Kazumasa; Arima, Ken; Kogawa, Rikitake; Takahashi, Fumiyuki; Kotani, Tomobumi; Okubo, Kimie; Fukushima, Seiji; Itou, Satoru; Kondo, Kunio; Chiku, Masaaki; Ohno, Yasumi; Onikura, Motoyuki; Hirayama, Atsushi

doi:10.3390/jcm9010167

Cited by 12 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most recently, a prospective Garfield‐AF Registry (Goto et al, 2019 ) including 35 countries and over 33,000 patients showed moderate‐to‐severe CKD was independently associated with mortality in newly diagnosed AF, and this effect is even greater in patients from Asia than the rest of the world. Another Japanese registry study (Yuzawa et al, 2020 ) also showed that an impaired renal function was significantly associated with all adverse events in AF patients (CrCl < 50 ml/min vs. CrCl≥80 ml/min, adjusted HR s: 2.53 for death, 2.53 for cardiovascular events).…”

Section: Discussionmentioning

confidence: 90%

“…The presence of renal dysfunction in AF patients was associated with a substantial increase in TE incidence and an increased risk of bleeding events (Potpara et al, 2018 ). Previous studies already demonstrated that moderate to severe renal impairment increased the risk of bleeding in AF patients (Abe et al, 2017 ; Banerjee et al, 2014 ; Cho et al, 2017 ; Yuzawa et al, 2020 ), but some other studies showed diffident results, renal impairment was not a risk factor for bleeding (Boriani et al, 2016; Kodani et al, 2018 ). This study showed renal dysfunction was not an independent predictor for major bleeding.…”

Section: Discussionmentioning

confidence: 95%

“…Kodani et al showed worsening CrCl values were independently associated with all‐cause mortality and TE, but not with major hemorrhage in Japanese AF patients (Kodani et al, 2018 ). Nevertheless, other Japanese AF registry studies demonstrated that patients with Lower CrCl had a high risk for death, cardiovascular events, TE, and major bleeding (Abe et al, 2017 ; Yuzawa et al, 2020 )). These different results may be considered in the condition of confounding factors such as race, co‐morbidity, degree of renal impairment, and antithrombotic therapy.…”

Section: Introductionmentioning

confidence: 96%

“…Nevertheless, other Japanese AF registry studies demonstrated that patients with Lower CrCl had a high risk for death, cardiovascular events, TE, and major bleeding (Abe et al, 2017;Yuzawa et al, 2020)). These different results may be considered in the condition of confounding factors such as race, co-morbidity, degree of renal impairment, and antithrombotic therapy.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Relationship between creatinine clearance and clinical outcomes in Chinese emergency patients with atrial fibrillation

Wang

Zhang

Yang

et al. 2022

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Background: Few real-world data on the relation between creatinine clearance (CrCl) and adverse clinical outcomes in Chinese emergency department (ED) patients with nonvalvular atrial fibrillation (AF). Methods:In this prospective, observational, multicenter AF study, enrolled AF patients presenting to an ED at 20 hospitals in China from November 2008 to October 2011, with a follow-up of 12 month. A total of 863 AF patients with CrCl data were analyzed, and patients were categorized as CrCl ≥ 80, 50 ≤ CrCl < 80, 30 ≤ CrCl < 50, and CrCl < 30(ml/min). Outcomes of analyses were all-cause death, cardiovascular death, thromboembolism (TE), and major bleeding.Results: Among the whole patients, 126(14.6%) patients died during 12-month follow-up, 53(40.2%) among CrCl < 30 ml/min group, and 48(16.2%), 22(6.5%), and 3(3.2%) among 30 ≤ CrCl50, 50 ≤ Crl < 80, and CrCl ≥ 80 ml/min groups, respectively (p < 0.001). Cardiovascular death and TE rates also increased with decreasing CrCl. On multivariate analysis, patients with CrCl < 30 ml/min were associated with higher risks of all-cause death (HR 5.567;; p = .007) and higher cardiovascular death (HR11.939; 95%CI1.439-99.031; p = .022) as compared with CrCl≥80 ml/min category. Nevertheless, for TE and major bleeding risk, CrCl groups showed no significant difference after adjustment for variables in CHA 2 DS 2 -VASc score and status of warfarin prescription in our cohort. Conclusions:In Chinese ED nonvalvular AF patients, incidence rates of death increased with reducing CrCl across the whole range of renal function. CrCl < 30 ml/ min was associated with all-cause death, cardiovascular death, but not for TE and major bleeding.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relationship between creatinine clearance and clinical outcomes in Chinese emergency patients with atrial fibrillation

Wang

Zhang

Yang

et al. 2022

Noninvasive Electrocardiol

View full text Add to dashboard Cite

show abstract

“…As renal function declines, patients are at an increasing risk of thrombosis, bleeding and death [29,30]. From the pivotal phase III DOAC trials in VTE and NVAF, DOACs have been deemed safe and effective in patients with CKD stages 1-3; however, these RCTs excluded patients with creatinine clearance (CrCl) less than 25-30 ml/min [31].…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Direct oral anticoagulant use in special populations

Lamarche

Alrajhi

Wells

2021

Current Opinion in Pulmonary Medicine

View full text Add to dashboard Cite

Purpose of reviewThe pivotal phase III trials demonstrating efficacy and safety of direct oral anticoagulants (DOACs) in the treatment of venous thromboembolism (VTE) or nonvalvular atrial fibrillation (NVAF) excluded patients with important and common comorbidities, including obesity, advanced chronic kidney disease, cirrhosis, cancer and antiphospholipid antibody syndrome. Despite the lack of large prospective randomized control trials in these patient populations, the use of DOACs has led to a wealth of efficacy and safety data within these groups. Recent findingsRetrospective studies, meta-analyses, national databases and pharmacokinetic data have shed light on the efficacy and safety of DOACs in these patient populations. Although DOACs should be avoided in those with high-risk triple positive antiphospholipid antibody syndrome, advanced cirrhosis, advanced kidney disease and intact gastrointestinal cancers, and used with caution in genitourinary cancers, their use extends beyond the inclusion criteria of the initial randomized control trials. SummaryDOACs have revolutionized anticoagulant management and have become the cornerstone for VTE treatment and stroke prevention in NVAF. The decision to use DOACs must be individualized. Patient preference, underlying comorbidities and informed consent must always be considered when selecting the most appropriate anticoagulant.

show abstract

Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study

Morimoto,

Hoshino,

Matsuo

et al. 2023

Am J Cardiovasc Drugs

View full text Add to dashboard Cite

Background We previously conducted a retrospective cohort study using chart review of oral anticoagulant-naïve Japanese patients with nonvalvular atrial fibrillation (NVAF) that assessed the risk of major bleeding and stroke/systemic embolism (SE) events of apixaban versus warfarin. Methods In this subgroup analysis, we compared the risk of major bleeding and stroke/SE events by stratifying patients into four subgroups matched 1:1 using propensity score matching (PSM) according to baseline creatinine clearance (CrCl; mL/min): ≥ 15 to < 30, ≥ 30 to < 50, ≥ 50 to < 80, and ≥ 80. Results Of the 7074 patients in the apixaban group and 4998 in the warfarin group eligible for inclusion in the analysis, 4385 were included in each group after PSM. Incidence rates of major bleeding and stroke/SE events were generally lower with apixaban versus warfarin across the CrCl subgroups. When all patients with a CrCl change of < 0 mL/min per year during the study period (apixaban, n = 3871; warfarin, n = 2635) were stratified into four subgroups based on the magnitude of CrCl decline (median CrCl change [mL/min] per year: − 1.09, − 3.48, − 7.54, and − 36.92 for apixaban, and − 1.10, − 3.65, − 7.85, and − 40.40 for warfarin), the incidence rates of major bleeding and stroke/SE events generally increased with an increasing CrCl decline per year in both groups. Conclusions In Japanese patients with NVAF, the safety and effectiveness of apixaban and warfarin were consistent across different renal subgroups, including those with severe renal impairment. Our results highlight the importance of monitoring renal function variations over time in patients with NVAF. ClinicalTrials.gov identifier NCT03765242. Supplementary Information The online version contains supplementary material available at 10.1007/s40256-023-00611-7.

show abstract

Relationship between the Renal Function and Adverse Clinical Events in Patients with Atrial Fibrillation: A Japanese Multicenter Registry Substudy

Cited by 12 publications

References 28 publications

Relationship between creatinine clearance and clinical outcomes in Chinese emergency patients with atrial fibrillation

Relationship between creatinine clearance and clinical outcomes in Chinese emergency patients with atrial fibrillation

Direct oral anticoagulant use in special populations

Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study

Contact Info

Product

Resources

About