Comparing the renal outcomes in patients with atrial fibrillation receiving different oral anticoagulants

We aimed to compare renal function changes in patients with atrial fibrillation (AF) prescribed different oral anticoagulants (OACs). We performed a retrospective analysis of Australian national primary care data. A total of 12,562 patients with AF and initiated OAC between 1 January 2013 and 31 December 2017 were included. Inverse probability of treatment weighting was used for balancing baseline characteristics and the risks of decline in estimated glomerular filtration rate (eGFR) in patients prescribed each OAC were compared. Compared with warfarin, prescribing of direct-acting oral anticoagulants (DOACs) was associated with a lower risk of renal function decline per 1000 person-years: hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.68–0.81, p < 0.001 for ≥30% decline in eGFR; HR 0.28, 95% CI 0.20–0.41, p < 0.001 for eGFR decline to ≤30 mL/min/1.73 m²; and HR 0.45, 95% CI 0.35–0.58, p < 0.001 for serum creatinine doubling. Compared with dabigatran, rivaroxaban use had a significantly lowered risk of decline in eGFR to ≤30 mL/min/1.73 m² (HR 0.29, 95% CI 0.13–0.66, p = 0.003) and risk of doubling of serum creatinine (HR 0.62, 95% CI 0.40–0.95, p = 0.030). The risk of renal function decline appeared to be lower in patients prescribed DOACs versus warfarin.