Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinische Wochenschrift 13-14/2018

04.06.2018 | original article

Renal function in patients with mechanical prosthetic valves

Long-term effects of anticoagulation and over-anticoagulation with warfarin

verfasst von: MD Yiğit Çanga, MD Tolga Sinan Güvenç, MD Ali Nazmi Çalık, MD Mehmet Baran Karataş, MD Evliya Akdeniz, MD Gizem Yüksel, MD Ayşe Emre

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 13-14/2018

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

Warfarin-related nephropathy (WRN) is a complication of warfarin over-anticoagulation that is associated with acute and/or chronic renal dysfunction and increased mortality. The long-term effects of warfarin on renal function has not been adequately studied in patients with a mechanical prosthetic valve (MPV).

Aim

To study the time-dependent effects of over-anticoagulation on renal function in patients with a MPV.

Methods

A total of 193 patients who underwent MPV implantation and were followed up in this study were eligible for inclusion. Time above therapeutic international normalized ratio (INR) range (TATR) was calculated by dividing the number of INR measurements above target in a year by the total number of INR measurements within a year. Patients were divided into quartiles according to average TATR at 60 months.

Results

At 60 months more patients within the 4th quartile had a ≥20% reduction in the estimated glomerular filtration rate (eGFR, 25.0%, p = 0.04) and chronic kidney disease (CKD, 33.0%, p = 0.07) compared to patients within the 1st quartile. High TATR remained a significant determinant for reduction in eGFR (odds ratio OR: 7.50, 95% confidence interval CI:1.55–36.32) and CKD (OR:5.15, 95% CI: 1.26–20.62) after adjusting for other variables. Longitudinal analysis revealed that the change in eGFR was related to the duration of warfarin use (p < 0.001) and the interaction between the duration of warfarin use and TATR (p = 0.03). Similar findings were observed in patients without CKD at baseline, but not in those with CKD before the index operation.

Conclusion

Anticoagulation over targeted INR values is associated with a steeper decline in eGFR and an increased frequency of CKD in patients with a MPV.
Literatur
1.
Zurück zum Zitat Brodsky SV, Collins M, Park E, Rovin BH, Satoskar AA, Nadasdy G, Wu H, Bhatt U, Nadasdy T, Hebert LA. Warfarin therapy that results in an international normalization ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease. Nephron Clin Pract. 2010;115:c142–6. CrossRefPubMedPubMedCentral Brodsky SV, Collins M, Park E, Rovin BH, Satoskar AA, Nadasdy G, Wu H, Bhatt U, Nadasdy T, Hebert LA. Warfarin therapy that results in an international normalization ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease. Nephron Clin Pract. 2010;115:c142–6. CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Wheeler DS, Giugliano RP, Rangaswami J. Anticoagulation-related nephropathy. J Thromb Haemost. 2016;14(3):461–7. CrossRefPubMed Wheeler DS, Giugliano RP, Rangaswami J. Anticoagulation-related nephropathy. J Thromb Haemost. 2016;14(3):461–7. CrossRefPubMed
3.
Zurück zum Zitat Fanola CL, Mooney D, Cowan AJ, Ko D, Sisson EK, Henault LE, Tripodis Y, Hylek EM. Incidence of severe renal dysfunction among individuals taking warfarin and implications for non-vitamin K oral anticoagulants. Am Heart J. 2017;184:150–5. CrossRefPubMed Fanola CL, Mooney D, Cowan AJ, Ko D, Sisson EK, Henault LE, Tripodis Y, Hylek EM. Incidence of severe renal dysfunction among individuals taking warfarin and implications for non-vitamin K oral anticoagulants. Am Heart J. 2017;184:150–5. CrossRefPubMed
4.
Zurück zum Zitat Krishna VN, Warnock DG, Saxena N, Rizk DV. Oral anticoagulants and risk of nephropathy. Drug Saf. 2015;38(6):527–523. CrossRef Krishna VN, Warnock DG, Saxena N, Rizk DV. Oral anticoagulants and risk of nephropathy. Drug Saf. 2015;38(6):527–523. CrossRef
5.
Zurück zum Zitat Logan I, Sheerin NS. Anticoagulation and kidney injury: rare observation or common problem? J Nephrol. 2013;26:603–5. CrossRefPubMed Logan I, Sheerin NS. Anticoagulation and kidney injury: rare observation or common problem? J Nephrol. 2013;26:603–5. CrossRefPubMed
6.
Zurück zum Zitat An JN, Ahn SY, Yoon CH, Youn TJ, Han MK, Kim S, Chin HJ, Na KY, Chae DW. The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in Korean patients. PLoS ONE. 2013;8(4):e57661. CrossRefPubMedPubMedCentral An JN, Ahn SY, Yoon CH, Youn TJ, Han MK, Kim S, Chin HJ, Na KY, Chae DW. The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in Korean patients. PLoS ONE. 2013;8(4):e57661. CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Eikelboom JW, Connolly SJ, Brueckmann M, Granger CB, Kappetein AP, Mack MJ, Blatchford J, Devenny K, Friedman J, Guiver K, Harper R, Khder Y, Lobmeyer MT, Maas H, Voigt JU, Simoons ML, RE-ALIGN Investigators. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206–14. CrossRefPubMed Eikelboom JW, Connolly SJ, Brueckmann M, Granger CB, Kappetein AP, Mack MJ, Blatchford J, Devenny K, Friedman J, Guiver K, Harper R, Khder Y, Lobmeyer MT, Maas H, Voigt JU, Simoons ML, RE-ALIGN Investigators. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206–14. CrossRefPubMed
9.
Zurück zum Zitat Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12. CrossRefPubMedPubMedCentral Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12. CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710–8. CrossRefPubMed Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710–8. CrossRefPubMed
11.
Zurück zum Zitat Rizk DV, Warnock DG. Warfarin-related nephropathy: another newly recognized complication of an old drug. Kidney Int. 2011;80:131–3. CrossRefPubMed Rizk DV, Warnock DG. Warfarin-related nephropathy: another newly recognized complication of an old drug. Kidney Int. 2011;80:131–3. CrossRefPubMed
12.
Zurück zum Zitat Brodsky SV, Satoskar A, Chen J, Nadasdy G, Eagen JW, Hamirani M, Hebert L, Calomeni E, Nadasdy T. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases. Am J Kidney Dis. 2009;54(6):1121–6. CrossRefPubMed Brodsky SV, Satoskar A, Chen J, Nadasdy G, Eagen JW, Hamirani M, Hebert L, Calomeni E, Nadasdy T. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases. Am J Kidney Dis. 2009;54(6):1121–6. CrossRefPubMed
13.
14.
Zurück zum Zitat Kapoor KG, Bekaii-Saab T. Warfarin-induced allergic interstitial nephritis and leucocytoclastic vasculitis. Intern Med J. 2008;38:281–3. CrossRefPubMed Kapoor KG, Bekaii-Saab T. Warfarin-induced allergic interstitial nephritis and leucocytoclastic vasculitis. Intern Med J. 2008;38:281–3. CrossRefPubMed
15.
Zurück zum Zitat Moll S, Huffman J. Cholesterol emboli associated with warfarin treatment. Am J Hematol. 2004;77(2):194–5. CrossRefPubMed Moll S, Huffman J. Cholesterol emboli associated with warfarin treatment. Am J Hematol. 2004;77(2):194–5. CrossRefPubMed
16.
Zurück zum Zitat Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM, Bhatt UY, Hebert LA. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int. 2011;80(2):181–9. CrossRefPubMedPubMedCentral Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM, Bhatt UY, Hebert LA. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int. 2011;80(2):181–9. CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Najjar M, Yerebakan H, Sorabella RA, Guglielmetti L, Vandenberge J, Kurlansky P, Williams MR, Argenziano M, Smith CR, George I. Reversibility of chronic kidney disease and outcomes following aortic valve replacement. Interact Cardiovasc Thorac Surg. 2015;21(4):499–505. CrossRefPubMed Najjar M, Yerebakan H, Sorabella RA, Guglielmetti L, Vandenberge J, Kurlansky P, Williams MR, Argenziano M, Smith CR, George I. Reversibility of chronic kidney disease and outcomes following aortic valve replacement. Interact Cardiovasc Thorac Surg. 2015;21(4):499–505. CrossRefPubMed
18.
Zurück zum Zitat Thongprayoon C, Cheungpasitporn W, Kittanamongkolchai W, Srivali N, Greason KL, Kashani K. Changes in kidney function among patients undergoing transcatheter aortic valve replacement. J Renal. Inj Prev. 2017;6(3):216–21. CrossRef Thongprayoon C, Cheungpasitporn W, Kittanamongkolchai W, Srivali N, Greason KL, Kashani K. Changes in kidney function among patients undergoing transcatheter aortic valve replacement. J Renal. Inj Prev. 2017;6(3):216–21. CrossRef
Metadaten
Titel
Renal function in patients with mechanical prosthetic valves
Long-term effects of anticoagulation and over-anticoagulation with warfarin
verfasst von
MD Yiğit Çanga
MD Tolga Sinan Güvenç
MD Ali Nazmi Çalık
MD Mehmet Baran Karataş
MD Evliya Akdeniz
MD Gizem Yüksel
MD Ayşe Emre
Publikationsdatum
04.06.2018
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 13-14/2018
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-018-1350-z

Weitere Artikel der Ausgabe 13-14/2018

Wiener klinische Wochenschrift 13-14/2018 Zur Ausgabe

MUW researcher of the month

MUW researcher of the month

mitteilungen der gesellschaft der ärzte in wien

Vorschau auf das Wintersemester 2018/19: