Armentaro Giuseppe, D'Arrigo Graziella, Bo Mario, Cassano Velia, Miceli Sofia, Pitino Annalisa, Tripepi Giovanni, Romeo Santina Maria Grazia, Sesti Giorgio, Lip Gregory Y H, Pastori Daniele, Gori Mercedes, Sciacqua Angela
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Institute of Clinical Physiology (IFC-CNR), Section of Reggio Calabria, Reggio Calabria, Italy.
Front Pharmacol. 2023 Jul 4;14:1210560. doi: 10.3389/fphar.2023.1210560. eCollection 2023.
Atrial Fibrillation (AF) and chronic kidney disease frequently coexist in the elderly. Warfarin-like drugs (WLDs) may be associated with a relatively greater decrease of estimated glomerular filtration rate (eGFR) as compared to direct oral anticoagulants (DOACs), but there is no evidence on the medium- and long-term changes. To further elucidate this issue in elderly patients with AF, we investigated the renal function deterioration in the two groups of the study (DOACs or WLDs). A total of 420 AF patients were enrolled (mean age: 77.0 ± 6.0 years; 136 on WLDs and 284 on DOACs). These patients underwent three eGFR measurements during the follow-up period. The between-arms difference of eGFR decline over time was investigated by Linear Mixed Models and group-based trajectory model analyses. In the whole study cohort, after a median follow-up of 4.9 years (interquartile range: 2.7-7.0 years), eGFR decreased from 67.4 ± 18.2 to 47.1 ± 14.3 mL/min/1.73 m ( < 0.001). Remarkably, patients on DOACs experienced a significantly smaller eGFR decline than WLDs patients (-21.3% vs. -45.1%, < 0.001) and this was true both in the medium-term (-6.6 vs. -19.9 mL/min/1.73 m) and in the long-term (-13.5 -34.2 mL/min/1.73 m) period. After stratification into five subgroups according to trajectories of renal function decline over time, logistic regression showed that DOACs patients had from 3.03 to 4.24-fold greater likelihood to belong to the trajectory with less marked eGFR decline over time than WLDs patients. Elderly patients with AF on treatment with DOACs had a relatively smaller decline of eGFR over time compared to those on treatment with WLDs. This is consistent with what was partly reported in the literature.
心房颤动（AF）与慢性肾脏病在老年人中常同时存在。与直接口服抗凝剂（DOACs）相比，类华法林药物（WLDs）可能与估算肾小球滤过率（eGFR）相对更大幅度的下降有关，但尚无关于中长期变化的证据。为了进一步阐明老年AF患者的这一问题，我们研究了两组研究对象（DOACs组或WLDs组）的肾功能恶化情况。共纳入420例AF患者（平均年龄：77.0±6.0岁；136例使用WLDs，284例使用DOACs）。这些患者在随访期间接受了3次eGFR测量。通过线性混合模型和基于组的轨迹模型分析研究了eGFR随时间下降的组间差异。在整个研究队列中，中位随访4.9年（四分位间距：2.7 - 7.0年）后，eGFR从67.4±18.2降至47.1±14.3 mL/min/1.73 m²（P<0.001）。值得注意的是，DOACs组患者的eGFR下降幅度明显小于WLDs组患者（-21.3%对-45.1%，P<0.001），在中期（-6.6对-19.9 mL/min/1.73 m²）和长期（-13.5对-34.2 mL/min/1.73 m²）均如此。根据肾功能随时间下降的轨迹分层为五个亚组后，逻辑回归显示，DOACs组患者随时间eGFR下降不明显的轨迹的可能性比WLDs组患者高3.03至4.24倍。与使用WLDs治疗的老年AF患者相比，使用DOACs治疗的患者随时间eGFR下降相对较小。这与文献中部分报道一致。
