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Acute Kidney Injury in Different Anticoagulation Strategies: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

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Abstract

Purpose

Acute kidney injury (AKI) following anticoagulant application has received growing attention as a significant emerging complication of anticoagulation. Nevertheless, there remains a lack of real-world studies to compare the incidence, clinical features, and prognosis of AKI across different anticoagulant regimens.

Methods

Disproportionality analysis and Bayesian analysis were used to identify suspected AKI cases after different anticoagulant use within the Food and Drug Administration’s Adverse Event Reporting System from January 2004 to March 2023. The time to onset, fatality, and hospitalization rates of anticoagulant-associated AKI were also investigated.

Results

We identified 9313 anticoagulant-associated AKIs, which appeared to influence mostly patients over 65 years old (65.37%). Lepirudin displayed a stronger AKI association than others, based on the highest reporting odds ratio (ROR = 6.66, 95% CI = 3.97–11.18), proportional reporting ratio (PRR = 6.08, χ2 = 69.12), and empirical Bayes geometric mean (EBGM = 6.08, the lower 90% one-sided CI = 3.95). Warfarin showed the slightest association with AKI in oral anticoagulants, lower than any direct oral anticoagulants excluding apixaban. Edoxaban exhibited the highest potential renal risk among direct oral anticoagulants, with an ROR of 3.32 (95% CI = 2.95–3.72). The median time to AKI onset was 36 (IQR 7–205) days following the initiation of anticoagulation therapy, and most AKI cases occurred within the first month.

Conclusion

Particular attention should be directed toward monitoring renal function in individuals receiving anticoagulants, including warfarin and direct oral anticoagulants, as well as other anticoagulant agents. This diligence is particularly imperative within the first month after anticoagulant administration for individuals with a tendency for AKI.

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Data Availability

All necessary data have been presented as tables and figures in the manuscript. Related information is accessible upon request to the corresponding author.

Code Availability

Related codes are accessible upon request to the corresponding author.

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Funding

This work was supported by the National High Level Hospital Clinical Research Funding under Grant [2022-PUMCH-B-020]&[2022-PUMCH-B-021], and Bethune Charitable Foundation under Grant [J202103E006] (G.C.)

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Authors and Affiliations

  1. Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China

    Qiuyu Xu, Gang Chen, Sanxi Ai, Ke Zheng & Xuemei Li

  2. Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China

    Bin Zhao

Authors
  1. Qiuyu Xu
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  2. Gang Chen
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  3. Sanxi Ai
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  4. Ke Zheng
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  6. Xuemei Li
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Qiuyu Xu, Gang Chen, and Bing Zhao. Validation and supervision were conducted by Sanxi Ai, Ke Zheng, and Xuemei Li. The first draft of the manuscript was written by Qiuyu Xu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Gang Chen or Bin Zhao.

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Xu, Q., Chen, G., Ai, S. et al. Acute Kidney Injury in Different Anticoagulation Strategies: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data. Cardiovasc Drugs Ther (2024). https://doi.org/10.1007/s10557-024-07558-0

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