Relationship between renal damage marker levels and the presence of bleeding in patients with atrial fibrillation and chronic kidney disease receiving rivaroxaban

Abstract

Relevance. Chronic kidney disease (CKD) is often concomitant pathology in patients with atrial fibrillation (AF). Because of the increased risk of bleeding in patients with AF and CKD while taking anticoagulant therapy, it is necessary to assess new methods for predicting the risk of bleeding when prescribing anticoagulants in this category of patients.Objective. To evaluate the possible relationship between the presence of bleeding in patients with AF and CKD C3–4 receiving rivaroxaban and the level of renal damage markers in urine.Methods. One hundred and thirty-three patients with AF and CKD C3a-C4 aged 52 to 97 years (median age 82 [74;86] years) were included in the study. All patients were assessed for bleeding and excretion of markers of renal damage (albumin; nephrin; neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1)) in with urine have been identified. In addition, the levels of kidney injury markers in the urine of 45 healthy volunteers were analyzed.Results. Urinary NGAL and KIM-1 levels in patients with AF and CKD with a history of bleeding (5.5 [3.81;23.83] ng/ml and 0.68 [0.27;1.10] ng/ml, respectively) were significantly higher than those in patients without bleeding (4.19 [2.22; 15.53] ng/ml, p=0.039, and 0.38 [0.13;0.66] ng/ml, p=0.019, respectively) and healthy subjects (2.6 [1.9;4.3] ng/ml, p<0.001, and 0.21 [0.10;0.69], p=0.003, respectively).Conclusion. Patients with AF and CKD C3a — C4 on rivaroxaban treatment with a history of bleeding have higher urinary excretion of KIM-1 and NGAL.