Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain.
Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain.
Eur J Clin Invest. 2018 Jun;48(6):e12907. doi: 10.1111/eci.12907. Epub 2018 Apr 22.
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.
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.
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).
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.
临床实践指南建议在服用非维生素 K 口服抗凝剂（NOAC）的房颤患者中定期监测肾功能；然而，关于日常生活条件下这些建议的遵守情况的信息却很少。我们旨在确定开始服用 NOAC 的非瓣膜性房颤（NVAF）患者遵守肾功能监测建议的情况及其对 NOAC 剂量适当性的影响。
本研究涉及对包括连续 NVAF 患者的多中心登记进行的回顾性分析，这些患者开始服用 NOAC（n=692）。在 1 年随访期间记录药物剂量变化和血清肌酐测定值。欧洲心律协会标准用于定义肾功能监测的适当性以及适当的 NOAC 剂量。
在随访期间（334±89 天），遵守肾功能监测建议的比例为 61%（n=425）。经多变量调整后，年龄（每增加 1 年的 OR×年：0.92（95%CI：0.89-0.95）P<.001）、肌酐清除率（每增加 1 毫升/分钟的 OR×毫升/分钟：1.02（95%CI：1.01-1.03）P<.001）和基线时适当的 NOAC 剂量（OR：1.54（95%CI：1.06-2.23），P=0.024）是适当肾功能监测的独立预测因素。遵守肾功能监测建议与 1 年后适当的 NOAC 剂量变化独立相关（OR：2.80（95%CI：1.01-7.80），P=0.049）。
开始服用 NOAC 的 NVAF 患者不遵守肾功能监测建议的情况很常见，尤其是肾功能障碍的老年患者。遵守肾功能监测建议与 1 年随访时适当的 NOAC 剂量相关。需要进一步研究来评估肾功能监测对预后的影响。
