Influence of renal function on anticoagulation control in patients with non-valvular atrial fibrillation taking vitamin K antagonists

Abstract

Background and Purpose: Chronic kidney disease (CKD) has been related to poor anticoagulation control and an increased risk of bleeding. This study aims to evaluate the association between impaired renal function (eGFR <60 mL/min/1.73 m2) and anticoagulation control in patients with non-valvular atrial fibrillation (AF) on vitamin K antagonists (VKA) therapy. We also assessed whether the predictive value of the SAMe-TT2R2 score prevailed for subgroups both with and without CKD. Methods: This is an ancillary analysis of 1381 patients from the PAULA study, which was a cross-sectional, retrospective and nationwide multicenter study. Results: A total of 370 patients had eGFR <60 mL/min/1.73 m2. Anticoagulation control levels progressively worsened across each stage of CKD. Multiple linear regression analysis showed CKD as an independent predictor of time in therapeutic range (TTR). In the subgroup of patients with preserved renal function, female sex, diet affecting INR, polypharmacy and amiodarone were associated with poorer TTR. The SAMe-TT2R2 score had a significant but modest predictive value for TTR<65% (AUC, area under the curve 0.558, P =.002). In the subgroup of patients with CKD, the SAMe-TT2R2 (>2 points) showed no significant predictive capacity for TTR (AUC 0.528, P =.354). The average TTR was similar for both sexes (P =.255), but with a higher percentage of males subjects with TTR ≥65% (P =.013). Conclusion: Chronic kidney disease is associated with poor anticoagulation control in patients with non-valvular AF taking VKA. The SAMe-TT2R2 score was not predictive of poor TTR in the subgroup with CKD, although a modest predictive value for poor TTR was found in those without CKD.