Vitamin K antagonist use and renal function in pre-dialysis patients.
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.
['Voskamp|Pauline Wm|PW|', 'Dekker|Friedo W|FW|', 'Rookmaaker|Maarten B|MB|', 'Verhaar|Marianne C|MC|', 'Bos|Willem Jan W|WJW|', 'van Diepen|Merel|M|', 'Ocak|Gurbey|G|']
chronic kidney disease coumarins epidemiology glomerular filtration rate