Rivaroxaban slows renal decline in NVAF patients

Compared with warfarin, rivaroxaban lowers the risk and rate of renal decline in patients with nonvalvular atrial fibrillation (NVAF), a new study reports.

Drawing from UK primary care electronic health records, the researchers evaluated 5,338 NVAF patients who were initiated on rivaroxaban 20 mg/day and 6,314 patients started on warfarin. Those with estimated glomerular filtration rate (eGFR) <50 mL/min/1.73m² or end-stage renal disease were deemed ineligible for enrolment.

Over a mean follow-up of 2.5 years, a total of 322 cases of doubling serum creatinine (SCr) levels, one of the study’s primary outcomes, were detected. Similarly, there were 1,179 instances of ≥30-percent decline in eGFR, while 22 patients progressed to ESRD.

Cox proportional hazards regression analysis found that the use of rivaroxaban suppressed the risk of SCr doubling by nearly 40 percent (hazard ratio [HR], 0.63, 95 percent confidence interval [CI], 0.49–0.81). Similarly, rivaroxaban also reduced the risk of a ≥30-percent drop in eGFR (HR, 0.76, 95 percent CI, 0.67–0.86).

In contrast, no such effect was reported for the risk of ESRD (HR, 0.77, 95 percent CI, 0.29–2.04).

Moreover, among those who did see declines in eGFR, the rate of deterioration was significantly slower in those taking rivaroxaban (2.03 vs 1.65 mL/min/1.73m²; p=0.03).

“Further evidence to support a causal association from randomized controlled trials and well-designed observational studies in other settings would help prescribers make more informed benefit–risk decisions regarding choice of long-term anticoagulant therapy for their patients,” the researchers said.