PDF(Pubmed)
Abstract：
UNASSIGNED: AF is a global health concern, with systemic complications including renal dysfunction. This systematic review and meta-analysis compares the effects of rivaroxaban, a Factor Xa inhibitor, and vitamin K antagonists (VKAs) on renal outcomes in AF patients.
UNASSIGNED: The study protocol is registered in PROSPERO (ID: CRD42023462756). We systematically searched the PubMed, Embase and Cochrane Library databases from 1 January 2017 to 30 June 2023 for real-world studies comparing the effects of rivaroxaban and VKAs on renal outcomes in AF patients, including acute kidney injury, a .30% decrease in estimated glomerular filtration rate, doubling of serum creatinine and worsening renal function. Subgroup analyses targeted diabetes, pre-existing kidney disease, the elderly (age .65 years) and Asian populations. The risk of bias was assessed used the Robins-I tool. HRs and 95% CIs were synthesised through a random-effects model. Two sensitivity analyses were performed, using a fixed-effects model and excluding conference abstracts.
UNASSIGNED: We identified 1,666 records. After screening, 14 studies comparing rivaroxaban and VKAs were included. Rivaroxaban exhibited superiority over VKAs in preventing: acute kidney injury (HR 0.68; 95% CI [0.61.0.77]; p<0.00001); a .30% decrease in estimated glomerular filtration rate (HR 0.71; 95% CI [0.60.0.84]; p<0.0001); doubling of serum creatinine (HR 0.50; 95% CI [0.36.0.70]; p<0.0001); and worsening renal function (HR 0.56; 95% CI [0.45.0.69]; p<0.00001). Subgroup and sensitivity analyses consistently confirmed rivaroxaban\'s favourable effects on renal outcomes in diabetes, pre-existing kidney disease, the elderly and Asian populations.
UNASSIGNED: Our findings support the preference of rivaroxaban over VKAs for renal outcomes in AF. The findings endorse rivaroxaban as the preferred anticoagulant to mitigate renal complications, offering clinicians valuable insights for tailored strategies.
UNASSIGNED: The study protocol is registered in PROSPERO (ID: CRD42023462756). We systematically searched the PubMed, Embase and Cochrane Library databases from 1 January 2017 to 30 June 2023 for real-world studies comparing the effects of rivaroxaban and VKAs on renal outcomes in AF patients, including acute kidney injury, a .30% decrease in estimated glomerular filtration rate, doubling of serum creatinine and worsening renal function. Subgroup analyses targeted diabetes, pre-existing kidney disease, the elderly (age .65 years) and Asian populations. The risk of bias was assessed used the Robins-I tool. HRs and 95% CIs were synthesised through a random-effects model. Two sensitivity analyses were performed, using a fixed-effects model and excluding conference abstracts.
UNASSIGNED: We identified 1,666 records. After screening, 14 studies comparing rivaroxaban and VKAs were included. Rivaroxaban exhibited superiority over VKAs in preventing: acute kidney injury (HR 0.68; 95% CI [0.61.0.77]; p<0.00001); a .30% decrease in estimated glomerular filtration rate (HR 0.71; 95% CI [0.60.0.84]; p<0.0001); doubling of serum creatinine (HR 0.50; 95% CI [0.36.0.70]; p<0.0001); and worsening renal function (HR 0.56; 95% CI [0.45.0.69]; p<0.00001). Subgroup and sensitivity analyses consistently confirmed rivaroxaban\'s favourable effects on renal outcomes in diabetes, pre-existing kidney disease, the elderly and Asian populations.
UNASSIGNED: Our findings support the preference of rivaroxaban over VKAs for renal outcomes in AF. The findings endorse rivaroxaban as the preferred anticoagulant to mitigate renal complications, offering clinicians valuable insights for tailored strategies.
摘要：
■AF是全球健康问题，全身并发症包括肾功能不全。本系统综述和荟萃分析比较了利伐沙班的效果，因子Xa抑制剂，和维生素K拮抗剂（VKAs）对房颤患者肾脏预后的影响。
■本研究方案注册于PROSPERO(ID:CRD42023462756)。我们系统地搜索了PubMed,2017年1月1日至2023年6月30日的Embase和Cochrane图书馆数据库，用于比较利伐沙班和VKAs对房颤患者肾脏结局的影响的真实世界研究。包括急性肾损伤,估计肾小球滤过率下降30%，血清肌酐倍增和肾功能恶化。亚组分析有针对性的糖尿病，预先存在的肾脏疾病，老年人（65岁）和亚洲人口。使用Robins-I工具评估偏倚风险。HR和95%CI是通过随机效应模型合成的。进行了两项敏感性分析，使用固定效果模型并排除会议摘要。
■我们确定了1666条记录。筛选后,包括14项比较利伐沙班和VKAs的研究。利伐沙班在预防急性肾损伤（HR0.68;95％CI[0.61.0.77];p<0.00001）;估计肾小球滤过率下降.30％（HR0.71;95％CI[0.60.0.84];p<0.0001）;血清肌酐加倍（HR0.50;95％CI[0.36.0.70];p<0.0001）;肾功能恶化[0.456％HR]亚组和敏感性分析一致证实了利伐沙班对糖尿病患者肾脏结局的有利作用，预先存在的肾脏疾病，老年人和亚洲人口。
■我们的研究结果支持利伐沙班优于VKAs对房颤患者肾脏结局的偏好。研究结果证明利伐沙班是减轻肾脏并发症的首选抗凝剂。为临床医生提供定制策略的宝贵见解。
■本研究方案注册于PROSPERO(ID:CRD42023462756)。我们系统地搜索了PubMed,2017年1月1日至2023年6月30日的Embase和Cochrane图书馆数据库，用于比较利伐沙班和VKAs对房颤患者肾脏结局的影响的真实世界研究。包括急性肾损伤,估计肾小球滤过率下降30%，血清肌酐倍增和肾功能恶化。亚组分析有针对性的糖尿病，预先存在的肾脏疾病，老年人（65岁）和亚洲人口。使用Robins-I工具评估偏倚风险。HR和95%CI是通过随机效应模型合成的。进行了两项敏感性分析，使用固定效果模型并排除会议摘要。
■我们确定了1666条记录。筛选后,包括14项比较利伐沙班和VKAs的研究。利伐沙班在预防急性肾损伤（HR0.68;95％CI[0.61.0.77];p<0.00001）;估计肾小球滤过率下降.30％（HR0.71;95％CI[0.60.0.84];p<0.0001）;血清肌酐加倍（HR0.50;95％CI[0.36.0.70];p<0.0001）;肾功能恶化[0.456％HR]亚组和敏感性分析一致证实了利伐沙班对糖尿病患者肾脏结局的有利作用，预先存在的肾脏疾病，老年人和亚洲人口。
■我们的研究结果支持利伐沙班优于VKAs对房颤患者肾脏结局的偏好。研究结果证明利伐沙班是减轻肾脏并发症的首选抗凝剂。为临床医生提供定制策略的宝贵见解。
