Abstract
The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of orally administered drugs to prevent thromboembolic events in patients with CKD who require anticoagulation: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Although VKAs remain the first-line treatment in patients with advanced CKD, treatment with VKAs is challenging due to difficulties in maintaining the appropriate anticoagulation level, tendency to accelerate vascular calcification and faster progression of CKD in patients treated with VKAs. On the other hand, the pleiotropic effect of DOACs, including vascular protection and anti-inflammatory properties along with comparable efficacy and safety of treatment with DOACs, compared to VKAs observed in preliminary reports encourages the use of DOACs in patients with CKD. This review summarizes the available data on the efficacy and safety of DOACs in patients with CKD and provides recommendations regarding the choice of the optimal drug and dosage depending on the CKD stage.
Highlights
Chronic kidney disease (CKD) is defined as kidney structure or function abnormality present for more than three months with health implications
Data about safety and efficacy of direct oral anticoagulants (DOACs) in chronic kidney disease (CKD) are limited, but there are a few studies in progress that may provide evidence of either superiority or inferiority of DOACs over vitamin K antagonists (VKAs)
DOACs are preferred over warfarin in patients with mild to moderate CKD and might be considered in patients with advanced CKD
Summary
Chronic kidney disease (CKD) is defined as kidney structure or function abnormality present for more than three months with health implications. 2011 study, using the Chronic Kidney Disease Collaboration formula (CKD-EPI). This prevalence is increasing, partially due to the aging of society. ESRD patients have times higher risk of bleeding, compared to those with no kidney disease [15]. Hemostasis disorders in patients with result from the systemic accumulation of the and metabolic compounds, which cause activation of the coagulation cascade and fibriuremic toxins and metabolic compounds, which cause activation of the coagulation casnolytic system, platelet hyperreactivity and damage of the endothelium [16]. Hemostasis in CKD are shown develop bleeding and thromboembolic episodes. In patients with ESRD, VKAs remain the first-line treatment, based on expert consensus It is unclear whether patients with CKD benefit from oral anticoagulation as much as those with normal kidney function. This review outlines the benefit–risk ratio of anticoagulants in advanced CKD and provides practical recommendations for treatment adjustment, reversal of antithrombotic effect and monitoring of the renal function on a regular basis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
