Rivaroxaban's Impact on Renal Decline in Patients With Nonvalvular Atrial Fibrillation: A US MarketScan Claims Database Analysis

Craig I Coleman, Reinhold Kreutz, Nitesh Sood, Thomas J Bunz, Anna-Katharina Meinecke, Daniel Eriksson, William L Baker, Craig I Coleman, Reinhold Kreutz, Nitesh Sood, Thomas J Bunz, Anna-Katharina Meinecke, Daniel Eriksson, William L Baker

Abstract

Warfarin has been associated with renovascular calcification and worsening renal function, whereas rivaroxaban may provide a degree of renopreservation by decreasing vascular inflammation. We sought to compare rivaroxaban and warfarin's impact on renal decline in patients with nonvalvular atrial fibrillation (NVAF) treated in routine practice. Using US MarketScan claims data from January 2012 to December 2017, we identified patients with NVAF newly initiated on rivaroxaban or warfarin with ≥12 months of continuous insurance coverage prior to initiation. Patients with stage 5 chronic kidney disease (CKD) or receiving hemodialysis at baseline were excluded. Outcomes included rates (events/100 person-years) of hospital or emergency department admission for acute kidney injury (AKI) or progression to stage 5 CKD or need for hemodialysis. Differences in baseline covariates between cohorts were adjusted using inverse probability-of-treatment weights based on propensity scores (absolute standardized differences <0.1 achieved for all covariates after adjustment). Patients were followed until an event, anticoagulant discontinuation/switch, insurance disenrollment, or end of data availability. Hazard ratios with 95% confidence intervals (CIs) were estimated using Cox regression. We assessed 36 318 rivaroxaban (19.8% received a dose <20 mg/d) and 36 281 warfarin users. Stages 3 and 4 CKD were present in 5% and 1% of patients at baseline, and proteinuria was present in 2%. Rivaroxaban was associated with a 19% (95% CI = 13%-25%) reduction in the hazard of AKI (rates = 4.91 vs 8.45) and an 18% (95% CI = 9%-26%) reduction in progression to stage 5 CKD or hemodialysis (rates = 2.67 vs 4.12). Rivaroxaban appears associated with lower hazards of undesirable renal end points versus warfarin in patients with NVAF.

Keywords: atrial fibrillation; kidney function decline; oral anticoagulation; rivaroxaban; warfarin.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Daniel Eriksson and Anne-Katherina Meinecke are employees of Bayer AG.

Figures

Figure 1.
Figure 1.
Incidence and hazard ratios for the comparison of rivaroxaban and warfarin for renal end points. CKD indicates chronic kidney disease; CI, confidence interval; HR, hazard ratio.
Figure 2.
Figure 2.
Incidence and hazard ratios for the comparison of rivaroxaban and warfarin on secondary endpoints. CI indicates confidence interval; HR, hazard ratio.
Figure 3.
Figure 3.
Results of subgroup analyses. ACEI indicates angiotensin-converting enzyme inhibitor; AKI, acute kidney injury; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; CI, confidence interval; HR, hazard ratio.

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