Abstract / Summary
Abstract Background Anticoagulant use can cause anticoagulant-related nephropathy (ARN), primarily characterized by acute kidney injury (AKI). The incidence and severity of AKI associated with the use of direct oral anticoagulants (DOACs) remain unclear. Methods This study aimed to examine the incidence of AKI in patients with nonvalvular atrial fibrillation (NVAF) receiving DOACs. This single-center, retrospective cohort study enrolled patients with NVAF who received edoxaban, apixaban, or rivaroxaban between January 2015 and December 2023. The primary outcome was the cumulative incidence of AKI within the first year of treatment. Inverse probability of treatment weighting (IPTW) was applied to adjust for imbalances in the measured confounders between treatment groups. Additionally, outcome regression was conducted including covariates in the weighted Cox proportional hazards model. Results Of the 492 enrolled patients, 307, 112, and 73 received edoxaban, apixaban, and rivaroxaban, respectively. The cumulative incidence of AKI within 1 year of the administration for each of these drugs was 10.8%, 23.3%, and 25.0%, respectively (IPTW-adjusted p < 0.001). In multivariable Cox regression analysis with IPTW adjustment, compared with edoxaban, apixaban and rivaroxaban showed adjusted hazard ratios of 2.12 (95% confidence intervals (CI), 1.12–4.02, p = 0.021) and 2.92 (95% CI, 1.44–5.92, p = 0.003), respectively. Conclusion Edoxaban was associated with a lower risk of AKI than other factor Xa inhibitors.