To access this material please log in or register

Register Authorize

Anticoagulant therapy in patient with chronical kidney disease and atrial fibrillation

Esayan A. M.
Academician I. P. Pavlov First St. Petersburg State Medical University, L. Tolstogo 6/8, St.-Petersburg 197022

Keywords: chronic kidney disease, atrial fibrillation, new oral anticoagulants, rivaroxaban

DOI: 10.18087/rhfj.2017.4.2395

Chronic kidney disease (CKD) persists in every fourth patient with cardiovascular disease (CVD). The CKD is an independent risk factor for CVD and has the same high risk of cardiovascular complications as ischemic heart disease. Majority of patients with CKD do not know about serious disease and have been revealed in the terminal stage, when efforts for improvement of renal function are impossible. Therefore, it is necessary for doctors of all specialties to be informed about importance of the kidney pathology and also about simple criteria for diagnose CKD. CKD is a predisposing risk factor for atrial fibrillation (AF) along with arterial hypertension, chronic heart failure, ischemic heart disease and diabetes mellitus. Patients with AF in Russia have a high risk of stroke. Presence of CKD significantly increases this risk as well as other cardiovascular complications. New oral anticoagulants (NOAC) are the preferential choice for patients with CKD and non-valvular AF versus (over) vitamin K antagonists. Among the NOAC preference should be given to the drugs with predominantly non-renal clearance; with the best nephrologic profile and a strong evidence base; with asimple and reliable dosing algorithm for CKD; preferably, a single daily dosing. A special renal dose was studied only with rivaroxaban among NOAC in the phase III studies. The efficacy and safety of rivaroxaban for patients with CKD was proved in the comorbid population: with high risk of stroke and hemorrhage Algorithm of Rivaroxaban’s dosing is simple and provides doctors quickly right dose selection and promotes high adherence in the patient population.
  1. WHO Global Report. 2008–2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. WHO; 2009. 42 p.
  2. Мухин Н. А., Смирнов А. В., Кобалава Ж. Д., Бобкова И. Н., Виллевальде С. В., Козловская Л. В. и др. Сердечно-Сосудистый Риск И Хроническая Болезнь Почек: Стратегии Кардио-Нефропротекции. Российский Кардиологический Журнал. 2014;8 (112):7–37.
  3. Швецов М. Ю., Бобкова И. Н., Колина И. Б., Камышова Е. С. Хроническая болезнь почек и нефропротективная терапия. Методическое руководство для врачей. М.; 2012. 83 с.
  4. Lassnigg A, Schmid ER , Hiesmayr M, Falk C, Druml W, Bauer P et al. Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure? Crit Care Med. 2008;36 (4):1129–37. DOI:10.1097/CCM.0b013e318169181a.
  5. Есаян А. М. Эссенциальная гипертензия с нефропатией. насколько это актуально в наши дни? Нефрология. 2008;12 (2):16–22.
  6. Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM at al. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J. 2010;31 (6):703–11. DOI:10.1093/eurheartj/ehp507.
  7. Saab G, Whaley-Connell AT, McCullough PA, Bakris GL. CKD awareness in the United States: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2008;52 (2):382–3. DOI:10.1053/j.ajkd.2008.05.026.
  8. Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3 (1):1–163.
  9. Рабочая группа Научного общества нефрологов России. Национальные рекомендации. Хроническая болезнь почек: основные положения, определение, диагностика, скрининг, подходы к профилактике и лечению. Санкт-Петербург: Левша; 2012. 52 с.
  10. Мосина Н. В., Есаян А. М. Артериальная гипертензия и протеинурия – важнейшые факторы прогрессирования почечной недостаточности. Нефрология. 2004;8 (1):22–8.
  11. Карабаева А. Ж., Есаян А. М., Каюков И. Г. Дисфункция эндотелия в патогенезе кардиоренальной патологии. Клинико-лабораторный консилиум. 2007;17:15–21.
  12. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130 (6):461–70.
  13. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16 (1):31–41.
  14. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375 (9731):2073–81. DOI:10.1016/S0140–6736 (10) 60674–5.
  15. van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79 (12):1341–52. DOI:10.1038/ki.2010.536.
  16. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37 (38):2893–962. DOI:10.1093/eurheartj/ehw210.
  17. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2014;64 (21):e1–76. DOI:10.1016/j.jacc.2014.03.022.
  18. Bansal N, Xie D, Tao K, Chen J, Deo R , Horwitz E et al. Atrial Fibrillation and Risk of ESRD in Adults with CKD. Clinical Journal of the American Society of Nephrology. 2016;11 (7):1189–96. DOI:10.2215/CJN.10921015.
  19. Somasundaram K, Ball J. Medical emergencies: atrial fibrillation and myocardial infarction: Atrial fibrillation and myocardial infarction. Anaesthesia. 2013;68:84–101. DOI:10.1111/anae.12050.
  20. Pokorney SD, Simon DN, Thomas L, Fonarow GC, Kowey PR, Chang P et al. Patients’ time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry. American Heart Journal. 2015;170 (1):141–148.e1. DOI:10.1016/j.ahj.2015.03.017.
  21. Gallagher AM, Setakis E, Plumb JM, Clemens A, van Staa T-P. Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients: Thrombosis and Haemostasis. 2011;106 (5):968–77. DOI:10.1160/TH11-05-0353.
  22. Böhm M, Ezekowitz MD, Connolly SJ, Eikelboom JW, Hohnloser SH, Reilly PA et al. Changes in Renal Function in Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2015;65 (23):2481–93. DOI:10.1016/ j.jacc.2015.03.577.
  23. Zhang Y-T, Tang Z-Y. Research Progress of Warfarin-associated Vascular Calcification and Its Possible Therapy: Journal of Cardiovascular Pharmacology. 2014;63 (1):76–82. DOI:10.1097/FJC.0000000000000008.
  24. Chatrou MLL, Winckers K, Hackeng TM, Reutelingsperger CP, Schurgers LJ. Vascular calcification: The price to pay for anticoagulation therapy with vitamin K-antagonists. Blood Reviews. 2012;26 (4):155–66. DOI:10.1016/j.blre.2012.03.002.
  25. Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM at al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney International. 2011;80 (2):181–9. DOI:10.1038/ki.2011.44.
  26. Beazley KE, Deasey S, Lima F, Nurminskaya MV. Transglutaminase 2-Mediated Activation of - Catenin Signaling Has a Critical Role in Warfarin-Induced Vascular Calcification. Arteriosclerosis, Thrombosis, and Vascular Biology. 2012;32 (1):123–30. DOI:10.1161/ATVBAHA.111.237834.
  27. Han KH, O’Neill WC. Increased Peripheral Arterial Calcification in Patients Receiving Warfarin. Journal of the American Heart Association. 2016;5 (1):e002665. DOI:10.1161/JAHA.115.002665.
  28. Howe AM, Webster WS. Warfarin exposure and calcification of the arterial system in the rat. Int J Exp Pathol. 2000;81 (1):51–6.
  29. Raggi P. Progression of Coronary Artery Calcium and Risk of First Myocardial Infarction in Patients Receiving Cholesterol-Lowering Therapy. Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24 (7):1272–7. DOI:10.1161/01.ATV.0000127024.40516.ef.
  30. Ross EA. Evolution of Treatment Strategies for Calciphylaxis. American Journal of Nephrology. 2011;34 (5):460–7. DOI:10.1159/000332221.
  31. Brodsky SV, Satoskar A, Chen J, Nadasdy G, Eagen JW, Hamirani M et al. Acute Kidney Injury During Warfarin Therapy Associated With Obstructive Tubular Red Blood Cell Casts: A Report of 9 Cases. American Journal of Kidney Diseases. 2009;54 (6):1121–6. DOI:10.1053/j.ajkd.2009.04.024.
  32. Narasimha Krishna V, Warnock DG, Saxena N, Rizk DV. Oral Anticoagulants and Risk of Nephropathy. Drug Safety. 2015;38 (6):527–33. DOI:10.1007/s40264-015-0290-z.
  33. Shafi ST, Negrete H, Roy P, Julius CJ, Sarac E. A case of dabigatran-associated acute renal failure. WMJ. 2013;112 (4):173–175; quiz 176.
  34. Kadiyala D, Brewster UC, Moeckel GW. Dabigatran induced acute kidney injury. San Diego, CA. 2012; (November 1–4):FR-PO1122.
  35. Ryan M, Ware K, Qamri Z, Satoskar A, Wu H, Nadasdy G et al. Warfarin-related nephropathy is the tip of the iceberg: direct thrombin inhibitor dabigatran induces glomerular hemorrhage with acute kidney injury in rats. Nephrology Dialysis Transplantation. 2014;29 (12):2228–34. DOI:10.1093/ndt/gft380.
  36. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. New England Journal of Medicine. 2009;361 (12):1139–51. DOI:10.1056/NEJMoa0905561.
  37. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. New England Journal of Medicine. 2011;365 (10):883–91. DOI:10.1056/NEJMoa1009638.
  38. Granger CB, Alexander JH, McMurray JJV, Lopes RD, Hylek EM, Hanna M at al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. New England Journal of Medicine. 2011;365 (11):981–92. DOI:10.1056/NEJMoa1107039.
  39. Инструкция по применению лекарственного препарата для медицинского применения Ксарелто® 15/20 мг ЛП-001457 [Интернет]. [цитируется по 1 июль 2017г.]. Доступно на: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=082b82c0-6225-481a-a575-befc31da5d49&t=
  40. Инструкция по применению лекарственного препарата для медицинского применения Эликвис® ЛП-002007 [Интернет]. [цитируется по 1 июль 2017г.]. Доступно на: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=3e7c7f8b-6695-432f-97f6-ead24eae7578&t=
  41. Инструкция по применению лекарственного препарата для медицинского применения Прадакса® ЛП-000872 [Интернет]. [цитируется по 1 июль 2017г.]. Доступно на: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=5e6df8af-6fb4-4c1a-9aa6-f554f12b862a&t=
  42. Dahal K, Kunwar S, Rijal J, Schulman P, Lee J. Stroke, Major Bleeding, and Mortality Outcomes in Warfarin Users With Atrial Fibrillation and Chronic Kidney Disease. Chest. 2016;149 (4):951–9. DOI:10.1378/chest.15–1719.
  43. Committee for Medicinal Products for Human use. Guideline on the evaluation of the pharmacokinetics of medicinal products in patients with decreased renal function. London: European Medicines Agency; 2016. 15 p.
  44. Каюков И. Г., Есаян А. М., Ничик Т. Е. Морфологические изменения почек при артериальной гипертензии в сочетании с умеренной протеинурией. Нефрология. 2006;10 (4):66–71.
  45. Лукьянов М. М., Бойцов С. А., Якушин С. С., Марцевич С. Ю., Воробьев А. Н., Загребельный А. В. и др. Диагностика, лечение, сочетанная сердечно-сосудистая патология и сопутствующие заболевания у больных с диагнозом «фибрилляция предсердий» в условиях реальной амбулаторно-поликлинической практики (по данным регистра кардиоваскулярных заболеваний РЕКВАЗА). Рациональная Фармакотерапия В Кардиологии. 2014;10 (4):366–77.
  46. Olesen JB, Lip GYH, Kamper A-L, Hommel K, Køber L, Lane DA et al. Stroke and Bleeding in Atrial Fibrillation with Chronic Kidney Disease. New England Journal of Medicine. 2012;367 (7):625–35. DOI:10.1056/NEJMoa1105594.
  47. Fox KAA, Piccini JP, Wojdyla D, Becker RC, Halperin JL, Nessel CC et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. European Heart Journal. 2011;32 (19):2387–94. DOI:10.1093/eurheartj/ehr342.
  48. Hijazi Z, Hohnloser SH, Oldgren J, Andersson U, Connolly SJ, Eikelboom JW et al. Efficacy and Safety of Dabigatran Compared With Warfarin in Relation to Baseline Renal Function in Patients With Atrial Fibrillation: A RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) Trial Analysis. Circulation. 2014;129 (9):961–70. DOI:10.1161/CIRCULATIONAHA.113.003628.
  49. Hohnloser SH, Hijazi Z, Thomas L, Alexander JH, Amerena J, Hanna M at al. Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. European Heart Journal. 2012;33 (22):2821–30. DOI:10.1093/eurheartj/ehs274.
  50. Fordyce CB, Hellkamp AS, Lokhnygina Y, Lindner SM, Piccini JP, Becker RC et al. On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With WarfarinClinical Perspective: Insights From ROCKET AF. Circulation. 2016;134 (1):37–47. DOI:10.1161/CIRCULATIONAHA.116.021890.
  51. Hijazi Z, Hohnloser SH, Andersson U, Alexander JH, Hanna M, Keltai M et al. Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial. JAMA Cardiology. 2016;1 (4):451. DOI:10.1001/jamacardio.2016.1170.
  52. McHorney CA, Crivera C, Laliberté F, Nelson WW, Germain G, Bookhart B et al. Adherence to non-vitamin-K-antagonist oral anticoagulant medications based on the Pharmacy Quality Alliance measure. Current Medical Research and Opinion. 2015;31 (12):2167–73. DOI:10.1185/03007995.2015.1096242.
  53. Beyer-Westendorf J, Ehlken B, Evers T. Real-world persistence and adherence to oral anticoagulation for stroke risk reduction in patients with atrial fibrillation. Europace. 2016;18 (8):1150–7. DOI:10.1093/europace/euv421.
  54. Mak K-H. Coronary and mortality risk of novel oral antithrombotic agents: a meta-analysis of large randomised trials. BMJ Open. 2012;2 (5):e001592. DOI:10.1136/bmjopen-2012–001592.
  55. Factor XA – Inhibition in RENal Patients With Non-valvular Atrial Fibrillation – Observational Registry [Internet]. ClinicalTrials.gov; 2017 [цитируется по 23 июль 2017 г.]. Доступно на: https://www.clinicaltrials.gov/ct2/show/NCT02663076
  56. Heidbuchel H, Verhamme P, Alings M, Antz M, Diener H-C, Hacke W et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015;17 (10):1467–507. DOI:10.1093/europace/euv309.
Esayan A. M. Anticoagulant therapy in patient with chronical kidney disease and atrial fibrillation. Russian Heart Failure Journal. 2017;18(4):243–252

To access this material please log in or register

Register Authorize
Ru En