Valoración de la función renal en pacientes con fibrilación auricular en tratamiento con anticoagulantes orales no antagonistas de la vitamina K

Résumé

Objectives: - To describe the prevalence of the use of different methods for assessing kidney function before prescribing non-Vitamin K antagonist oral anticoagulants (NOAC) in patients with atrial fibrillation (AF). - To identify discordances in the estimated kidney function and the recommended NOAC dosage using different equations for estimating kidney function in patients with AF. - To describe kidney function variations during NOAC treatment, to identify predictors of these variations and to determine the effect of these variations on the need for dosage adjustment. - To determine the compliance with current recommendations for kidney function monitoring in patients taking NOAC, to identify predictors of compliance with these recommendations and the association between an appropriate monitoring, dosage adjustment, and adequate NOAC dosage. Methodology: Compendium of publications regarding the kidney function assessment in AF patients undergoing NOAC treatment: - "Methods of kidney function assessment in non-valvular atrial fibrillation in the era of new oral anticoagulants". Cross-sectional study based on surveys of physicians about methods of kidney function assessment in AF patients. - "Comparison of Estimated Glomerular Filtration Rate Equations for Dosing New Oral Anticoagulants in Patients with Atrial Fibrillation". Cross-sectional analysis of patients with AF. Discordance in estimated renal function and recommended NOAC doses with different equations for kidney function assessment were studied. - "Impact of Variations in Kidney Function on Nonvitamin K Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Recent Acute Heart Failure". Observational study in patients with AF after hospitalization for acute decompensated heart failure. The need for NOAC dosage adjustment due to kidney function variation during follow-up was analysed. - "Kidney Function Monitoring and Non-vitamin K Oral Anticoagulant Dosage in Atrial Fibrillation". Retrospective study including AF patients who started NOAC. Compliance with recommendations for kidney function monitoring, predictors of this compliance and the association with adequate NOAC dosage were studied. Conclusions - There is great variability in the methods used to estimate kidney function for NOAC dosage adjustment. - The use of different equations can lead to significant discordances in the recommended NOAC dosage in patients with AF. - Significant variations in kidney function are common in patients with AF after hospitalization for acute decompensated heart failure. - Dosage adjustment needs may differ between NOAC in different patients with AF after hospitalization for acute decompensated heart failure. - A significant percentage of patients who start NOAC would require dosage adjustment due to kidney function variations during follow-up, but only a small fraction of these patients receive actual dosage changes. - Non-compliance with kidney function monitoring recommendations is common during the first year of NOAC treatment. - NOAC dosage adjustments were more frequent in patients with appropriate kidney function monitoring. - Prescription of inappropriate NOAC dosages for degree of kidney function is frequent. In these patients, adequate kidney function monitoring is independently associated with correct NOAC dosage after 1 year of treatment.