TY - JOUR
T1 - Vitamin K antagonist use and renal function in pre-dialysis patients
AU - Voskamp, Pauline W.M.
AU - Dekker, Friedo W.
AU - Rookmaaker, Maarten B.
AU - Verhaar, Marianne C.
AU - Bos, Willem Jan W.
AU - van Diepen, Merel
AU - Ocak, Gurbey
PY - 2018/5/29
Y1 - 2018/5/29
N2 - 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.
AB - 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.
KW - coumarins
KW - epidemiology
KW - chronic kidney disease
KW - glomerular filtration rate
UR - http://www.scopus.com/inward/record.url?scp=85047752236&partnerID=8YFLogxK
U2 - 10.2147/CLEP.S154719
DO - 10.2147/CLEP.S154719
M3 - Article
AN - SCOPUS:85047752236
SN - 1179-1349
VL - 10
SP - 623
EP - 630
JO - Clinical Epidemiology
JF - Clinical Epidemiology
ER -