Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Clin Interv Aging. 2013;8:523-9. doi: 10.2147/CIA.S44242. Epub 2013 May 10.
The purpose of this study was to examine whether long-term use of anticoagulants in elderly patients with atrial fibrillation (AF) and chronic kidney disease (CKD) influences renal function.
In this retrospective observational study, we reviewed the records of 2023 patients who attended our institution for treatment of CKD between January 2001 and September 2012. Inclusion criteria were having been under review for three months or more, age older than 60 years, permanent AF, a CHADS2 score > 2, and National Kidney Foundation Kidney Disease Outcomes Quality Initiative CKD stage 3-5. Sixty-one patients fulfilled these criteria, and were divided into those receiving antiplatelet anticoagulation (group A) and those receiving warfarin (group B). The results of laboratory investigations and estimated glomerular filtration rate (GFR) were recorded at months 3, 6, 12, and 18 from treatment initiation. We also recorded the occurrence of serious cardiovascular and neurological events, significant bleeding, and survival beyond 12 years.
Of the 61 patients enrolled, 35 were in group A and 26 were in group B. The mean international normalized ratio (INR) was 1.95 ± 1.01 (goal < 3.0). After adjustment for potential confounding variables, we found that patients in group B had a higher estimated GFR (6.06 ± 2.36 mL per minute, P = 0.01). Over a 12-year observation period, group B patients had significantly (P = 0.013) better survival than group A, with an adjusted hazard ratio for mortality of 0.318 (P = 0.022).
Warfarin therapy may delay deterioration in renal function and improve survival of elderly patients with CKD and AF.
本研究旨在探讨老年房颤（AF）合并慢性肾脏病（CKD）患者长期使用抗凝剂是否会影响肾功能。
本回顾性观察性研究纳入 2023 例于 2001 年 1 月至 2012 年 9 月在我院接受 CKD 治疗的患者，纳入标准为：至少接受 3 个月的治疗，年龄＞60 岁，持续性房颤，CHA2DS2-VASc 评分＞2 分，以及肾脏病预后质量倡议（Kidney Disease Outcomes Quality Initiative，KDIGO）CKD3-5 期。61 例患者符合这些标准，并分为接受抗血小板抗凝治疗（A 组）和华法林治疗（B 组）。在治疗开始后的 3、6、12 和 18 个月记录实验室检查和估算肾小球滤过率（estimated glomerular filtration rate，eGFR）结果。我们还记录了严重心血管和神经系统事件、大出血以及 12 年后的生存情况。
61 例患者中，A 组 35 例，B 组 26 例。国际标准化比值（international normalized ratio，INR）平均为 1.95±1.01（目标＜3.0）。调整潜在混杂因素后，我们发现 B 组患者的 eGFR 更高（6.06±2.36mL/min，P=0.01）。在 12 年的观察期间，B 组患者的生存率明显（P=0.013）高于 A 组，死亡风险的调整后危险比为 0.318（P=0.022）。
华法林治疗可能会延缓老年 CKD 合并 AF 患者肾功能恶化，提高生存率。
