Impaired Rivaroxaban Clearance in Mild Renal Insufficiency With Verapamil Coadministration: Potential Implications for Bleeding Risk and Dose Selection

2017 ◽  
Vol 58 (4) ◽  
pp. 533-540 ◽  
Author(s):  
David J. Greenblatt ◽  
Maulik Patel ◽  
Jerold S. Harmatz ◽  
Wayne T. Nicholson ◽  
Christopher M. Rubino ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Bleeding Risk ◽  
Dose Selection ◽  
Mild Renal Insufficiency

Efficacy and Bleeding Risk of Newer Anticoagulants Compared to Conventional Treatment in Patients with Chronic Kidney Disease- a Meta-Analysis of Randomized Controlled Trials

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2325-2325
Author(s):  
Srinath Sundararajan ◽  
Mugilan Poongkunran ◽  
Chithra Poongkunran ◽  
Arun Kannan ◽  
Saravananan Balamuthusamy
Keyword(s):  
Renal Insufficiency ◽  
Odds Ratio ◽  
Conventional Treatment ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Arterial Embolism ◽  
Severe Renal Insufficiency ◽  
Newer Anticoagulants ◽  
Moderate Renal Insufficiency ◽  
Mild Renal Insufficiency

Abstract Background Multiple newer oral anticoagulants (NOAC) are currently approved for the prevention, treatment of venous thromboembolism (VTE) and prevention of stoke in atrial fibrillation (AF). Most of the clinical trials with NOAC have excluded patients with severe renal insufficiency. There is a paucity of safety and efficacy data of NOAC in comparison with conventional treatment (CT) in patients with mild or moderate renal impairment. We performed a meta-analysis of the randomized control trials (RCTs) comparing NOAC to CT in patients with renal insufficiency to understand the safety and efficacy of NACs. Methods Medline, PubMed, EMBASE, EBSCO, CINAHL and Cochrane databases were queried with the keywords - "newer anticoagulants", "renal insufficiency", "dabigatran", "rivaroxaban", "apixaban", and "edoxaban". RCTs comparing NOAC to CT (warfarin, low molecular weight heparin, heparin, aspirin or placebo) were included. Non-randomized single arm trials were excluded. Authors of RCTs with missing pertinent data were contacted through electronic mail. The safety end point analyzed was clinically significant or major bleeding risk. The efficacy end points analyzed were incidence of arterial embolism in AF studies and venous thromboembolism in VTE studies. European Medical Agency classification of renal insufficiency was used, with mild renal insufficiency defined as estimated glomerular filtration rate (eGFR) from 50 to 79 and moderate renal insufficiency defined as eGFR of 30 to 49 and severe renal insufficiency defined as eGFR< 30. Results Sixteen RCTs with 115,147 patients fulfilled our inclusion criteria. Rivoroxaban, apixaban, edoxaban and dabigatran were the newer anticoagulants used in these 16 RCTs. Among these, 48,403 patients had either mild or moderate renal insufficiency. Patients with mild renal insufficiency treated with NAOC had lower bleeding risk [Odds ratio 0.81(CI 0.72-0.90) p<0.0001], lower incidence of arterial thromboembolism [Odds ratio 0.74(CI 0.64-0.85) p<0.0001] compared to conventional treatment. Patients with moderate renal insufficiency treated with NAOC had lower incidence of arterial thromboembolism [Odds ratio 0.74(CI 0.62-0.89) p=0.001] and a trend towards lower bleeding risk [Odds ratio 0.89(CI 0.66-1.18) p=0.41], compared to conventional treatment. Also, a trend of lowered VTE incidence was observed with NOAC compared to conventional treatment in patients with mild [Odds ratio 0.70(CI 0.46 to 1.070) p=0.1] as well moderate [Odds ratio 0.69(CI 0.34 to 1.41) p=0.31] renal insufficiency. Conclusion: Newer anticoagulants have decreased odds for VTE, arterial embolism and bleeding in patients with mild to moderate renal insufficiency compared to conventional treatment. Disclosures No relevant conflicts of interest to declare.

Kidney-Heart Connection: Experimental Mild Renal Insufficiency Induces Early Cardiac Fibrosis and Myocardial Diastolic Dysfunction Followed by Late Systolic Failure

2008 ◽  
Vol 14 (6) ◽  
pp. S17
Author(s):  
Fernando L. Martin ◽  
Josef Korinek ◽  
Brenda K. Huntley ◽  
Elise A. Oehler ◽  
Gerald E. Harders ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Diastolic Dysfunction ◽  
Cardiac Fibrosis ◽  
Mild Renal Insufficiency

Is Metformin Safe in Patients With Mild Renal Insufficiency?

Diabetes Care ◽  
2007 ◽  
Vol 30 (2) ◽  
pp. 444-444 ◽  
Author(s):  
A. Kazory ◽  
K. Walsh ◽  
E. Harman ◽  
Z. Talor
Keyword(s):  
Renal Insufficiency ◽  
Mild Renal Insufficiency

scholarly journals Mild Renal Insufficiency Results in Increases in Myocardial Collagen: Evidence for a Heart – Kidney Connection

2008 ◽  
Vol 22 (S1) ◽  
Author(s):  
Fernando L. Martin ◽  
Brenda K. Huntley ◽  
Gerald E. Harders ◽  
Horng H. Chen ◽  
Alessandro Cataliotti ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Myocardial Collagen ◽  
Mild Renal Insufficiency

Effect of Enalapril and Folic Acid Tablet on Contrast-induced Nephropathy in Patients with Mild Renal Insufficiency

2018 ◽  
Vol 06 (03) ◽  
Author(s):  
Chengchun Tang ◽  
Gaoliang Yan ◽  
Jiantong Hou ◽  
Xiaodong Pan ◽  
Zhongpu Chen ◽  
...  
Keyword(s):  
Folic Acid ◽  
Renal Insufficiency ◽  
Contrast Induced Nephropathy ◽  
Mild Renal Insufficiency

Even Mild Renal Insufficiency Is a Risk for Mortality after Heart Transplant

2013 ◽  
Vol 32 (4) ◽  
pp. S40
Author(s):  
M. Kittleson ◽  
J. Patel ◽  
M. Rafiei ◽  
A. Osborne ◽  
G. Jamero ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Heart Transplant ◽  
Mild Renal Insufficiency
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