Renal outcomes following oral anticoagulation in non-valvular atrial fibrillation: A multicentre, propensity-matched retrospective analysis in an Asian population

Background Direct oral anticoagulants (DOACs) have been linked to better renal outcomes than warfarin in non-valvular atrial fibrillation (NVAF). We aimed to compare the renal function outcomes in Asian NVAF patients treated with warfarin and DOAC. Methods This multicentre retrospective study analysed NVAF patients newly initiated on oral anticoagulant (OAC) from 2013 to 2022 across seven tertiary hospitals. Using propensity-score matching, warfarin and DOAC recipients were matched by incorporating 22 variables potentially affecting renal outcomes. Primary endpoints include clinically significant (≥30%) estimated glomerular filtration rate (eGFR) decline and worsened chronic kidney disease (CKD) stage. Results A total of 766 subjects (383 warfarin; 383 DOAC; mean age 70.7 ± 9.6 years) were analysed. Baseline eGFR was 75.0 (59.0–89.0) for warfarin and 76.0 (59.0–88.0) ml/min/1.73 m 2 for DOAC groups. Following median OAC treatment of 2.8 ± 1.6 years, 14.5% experienced clinically significant eGFR decline and 31.9% had worsened CKD stage. DOAC was associated with a lower risk of clinically significant eGFR decline (OR 0.529, 95% CI 0.343–0.817, p = 0.004) and worsened CKD stage (OR 0.713, 95% CI 0.521–0.975, p = 0.034). In subgroup analysis, rivaroxaban (OR 0.337, 95% CI 0.157–0.724, p = 0.005) and dabigatran (OR 0.516, 95% CI 0.285–0.934, p = 0.029), but not apixaban (OR 0.759, 95% CI 0.432–1.333, p = 0.338), were associated with a lower risk of clinically significant eGFR decline. Conclusions Significant renal function decline is common during follow-up of Asian NVAF patients on OAC. Among the DOACs, rivaroxaban and dabigatran, but not apixaban, were associated with a lower risk of renal function decline than warfarin. These findings warrant confirmation in prospective randomised studies.