Rivaroxaban vs Vitamin K Antagonist in Patients With Atrial Fibrillation and Advanced Chronic Kidney Disease
Reinhold Kreutz, Gilbert Deray, Jürgen Floege, Marianne Gwechenberger, Kai Hahn, Andreas R. Luft, Pontus B. Persson, Christoph Axthelm, Jürg H. Beer, Jutta Bergler‐Klein, Nicolas Lellouche, Jens Taggeselle, Craig I Coleman, Jan Beyer‐Westendorf, Albano Laetitia, Albert Catherine, Joachim Alexandre, Al-Zoebi Ayham, Annweiler Cédric, Auer Johann, Balgobin Sanjeet, B Joachim, Berami Ahmed, B. Jeanbaptiste, Biggar Patrick, B Wehrspohn Ralf, Bondke Christina, Bonin-Schnabel Renate, B. Hendrik, Bouiller Marc, Boureau Anne-Sophie, Brachmann Johannes, Brosche Jörg, Caudmont Sebastien, C. Guillaume, Charpy Vianney, Constans Joël, Dally Jean-Baptiste, De Geeter Guillaume, Debelle Fédéric, Decoulx Eric, Delarche Nicolas, Delle Karth Georg, Delsart Pascal, Derndorfer Michael, Desprets Laurent, Dillinger Jean-Guillaume, Dubart Camille, Eberhard Katrin, Sabine Eichinger-Hasenauer, Eissing Volker, Erley Christiane, Esteve Jean-Baptiste, Ferrari Emile, Fossey-Diaz Virginie, Fromentin Stéphane, Gallouj Karim, Gandjbakhch Estelle, Garnier Anne-Sophie, Gilis Laure, G Bertrand, Grundmann Franziska, Gueffet Isabelle, H. Sebastian, Haguenhauer Didier, Hannedouche Thierry, Häusler Karl Georg, Heinz Gerd-Ulrich, Herold Philipp, Hertting Klaus, Hoffer Etienne, Hoyer Joachim, Hügl Burkhard, Jänsch Sybille, Jean‐Louis Georges, J. Cutler Michael, Jung Werner, Kassis Samuel, Kellner Bernd-Thomas, Ketteler Marcus, Kielstein Jan Thomas, Koning René, Krämer Fabian, Krzesinski Jean-Marie, Lammers Ulrich, Lefebvre Jean-Marie, Eric Legrand, L. Matthias, Lodde Bernhard-Paul, Maalouli Christian, Mahnkopf Christian, Mailliez Sebastien, Mansourati Jacques, Marijon Eloi, Christian Meyer, Moll Detlev, Montalescot Gilles, Motte Serge, Mouquet Vincent, Nedeltchev Krassen
Abstract
Treatment with vitamin K antagonists (VKAs) has been linked to worsening of kidney function in patients with atrial fibrillation (AF). XARENO (Factor XA-inhibition in RENal patients with non-valvular atrial fibrillation Observational registry; NCT02663076) is a prospective observational study comparing adverse kidney outcomes in patients with AF and advanced chronic kidney disease receiving rivaroxaban or VKA. Patients with AF and an estimated glomerular filtration rate (eGFR) of 15 to 49 mL/min/1.73 m2 were included. Blinded adjudicated outcome analysis evaluated adverse kidney outcomes (a composite of eGFR decline to <15 mL/min/1.73 m2, need for chronic kidney replacement therapy, or development of acute kidney injury). A composite net clinical benefit outcome (stroke or systemic embolism, major bleeding, myocardial infarction, acute coronary syndrome, or cardiovascular death) was also analyzed. HRs with 95% CIs were calculated using propensity score overlap weighting Cox regression. There were 1,455 patients (764 rivaroxaban; 691 VKA; mean age 78 years; 44% females). The mean eGFR was 37.1 ± 9.0 in those receiving rivaroxaban and 36.4 ± 10.1 mL/min/1.73 m2 in those receiving VKA. After a median follow-up of 2.1 years, rivaroxaban was associated with less adverse kidney outcomes (HR: 0.62; 95% CI: 0.43-0.88) and all-cause death (HR: 0.76, 95% CI: 0.59-0.98). No significant differences were observed in net clinical benefit. In patients with AF and advanced chronic kidney disease, those receiving rivaroxaban had less adverse kidney events and lower all-cause mortality compared to those receiving VKA, supporting the use of rivaroxaban in this high-risk group of patients.