Deterioration of renal function is delayed in patients with atrial fibrillation treated with direct oral anticoagulants compared to vitamin K antagonists: systematic review and meta-analysis

Adamou et al., 2025 | Eur J Intern Med | Meta Analysis

Citation

Adamou Anastasia, Kyriakoulis Ioannis, ... Ntaios George. Deterioration of renal function is delayed in patients with atrial fibrillation treated with direct oral anticoagulants compared to vitamin K antagonists: systematic review and meta-analysis. Eur J Intern Med. 2025-Nov;141:106407. doi:10.1016/j.ejim.2025.07.003

Abstract

BACKGROUND: The use of anticoagulants has been linked to anticoagulant-related nephropathy, a condition initially reported in patients treated with warfarin. However, cases have also been documented in patients receiving direct oral anticoagulants (DOACs). We conducted a systematic review and meta-analysis to assess the comparative effect of DOACs versus Vitamin K antagonists (VKAs) in renal function deterioration in atrial fibrillation (AF) population. METHODS: According to the PRISMA reporting guidelines for systematic reviews and meta-analyses, we performed a comprehensive search in PubMed/MEDLINE and EMBASE (via Scopus), focusing on studies in AF patients treated with DOACs or VKAs and assessing their renal function over time. The studied outcomes were ≥30 % eGFR decline, progression to stage five chronic kidney disease (CKD) and doubling of serum creatinine. RESULTS: Among 4566 records, 13 studies with 302,071 patients were included with an overall follow-up period of 701,421.5 patient-years (mean:2.3 years per patient). DOACs were associated with a lower risk of ≥30 % eGFR decline (HR:0.72, 95 %CI:0.59-0.88), progression to stage five CKD (HR:0.49,95 %CI:0.37-0.64) and doubling of serum creatinine (HR:0.50, 95 %CI:0.42-0.61). ≥30 % eGFR decline was also lower when apixaban, dabigatran and rivaroxaban were compared separately to VKAs, (HR:0.81, 95 %CI:0.69-0.95), (HR:0.61, 95 %CI:0.48-0.78) and (HR:0.80, 95 %CI:0.70-0.92) respectively. There was no effect in progression to stage five CKD and doubling of serum creatinine, when apixaban was compared to VKAs. CONCLUSIONS: This systematic review and metanalysis of 13 studies and >300,000 patients with AF followed for an overall period of >700,000 patient-years showed that eGFR decline, progression to stage five CKD and doubling of serum creatinine are delayed in patients treated with DOACs compared to VKAs.

Key Findings

Among 4566 records, 13 studies with 302,071 patients were included with an overall follow-up period of 701,421.5 patient-years (mean:2.3 years per patient). DOACs were associated with a lower risk of ≥30 % eGFR decline (HR:0.72, 95 %CI:0.59-0.88), progression to stage five CKD (HR:0.49,95 %CI:0.37-0.64) and doubling of serum creatinine (HR:0.50, 95 %CI:0.42-0.61). ≥30 % eGFR decline was also lower when apixaban, dabigatran and rivaroxaban were compared separately to VKAs, (HR:0.81, 95 %CI:0.69-0

Outcomes Measured

• Requires manual extraction

Population

MeSH Terms

• Humans
• Atrial Fibrillation
• Anticoagulants
• Vitamin K
• Glomerular Filtration Rate
• Renal Insufficiency, Chronic
• Administration, Oral
• Disease Progression
• Creatinine

Evidence Classification

• Level: Meta Analysis
• Publication Types: Journal Article, Systematic Review, Meta-Analysis
• Vertical: vitamin-k

Provenance

• PMID: 40634145
• DOI: 10.1016/j.ejim.2025.07.003
• PMCID: Not in PMC
• Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09