Vitamin K antagonist use and renal function in pre-dialysis patients
Received 21 October 2017
Accepted for publication 18 February 2018
Published 29 May 2018 Volume 2018:10 Pages 623—630
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Professor Vera Ehrenstein
Pauline WM Voskamp,1 Friedo W Dekker,1 Maarten B Rookmaaker,2 Marianne C Verhaar,2 Willem Jan W Bos,3 Merel van Diepen,1 Gurbey Ocak2
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; 2Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands; 3Department of Nephrology, Sint Antonius Hospital, Nieuwegein, the Netherlands
Purpose: A post hoc analysis of a recent trial on direct oral anticoagulants versus vitamin K antagonists showed that amongst patients with mildly decreased kidney function, use of vitamin K antagonists was associated with a greater decline in renal function than use of direct oral anticoagulants. Whether these vitamin K antagonist effects are the same in pre-dialysis patients is unknown. Therefore, the aim of this study was to investigate the association between vitamin K antagonist use and the rate of renal function decline and time until start of dialysis in incident pre-dialysis patients.
Methods: Data from 984 patients from the PREdialysis PAtient REcord study, a multicenter follow-up study of patients with chronic kidney disease who started pre-dialysis care in the Netherlands (1999–2011), were analyzed. Of these patients, 101 used a vitamin K antagonist. Linear mixed models were used to compare renal function decline between vitamin K antagonist users and non-users. Cox proportional hazards models were used to estimate the HR with 95% CI for starting dialysis.
Results: Vitamin K antagonist use was associated with an extra change in renal function of –0.09 (95% CI –1.32 to 1.13) mL/min/1.73 m2 per year after adjustment for confounding. The adjusted HR for the start of dialysis was 1.20 (95% CI 0.85 to 1.69) in vitamin K antagonist users, compared to non-users.
Conclusion: In incident pre-dialysis patients, the use of vitamin K antagonists was not associated with an accelerated kidney function decline or an earlier start of dialysis compared to non-use. The lack of knowledge on the indication for vitamin K antagonist use could lead to confounding by indication.
Keywords: coumarins, epidemiology, chronic kidney disease, glomerular filtration rate
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]