Abstract
BackgroundWarfarin-related nephropathy (WRN) is a recently described disease entity, in which excessive warfarinization (international normalized ratio (INR) >3.0) causes acute kidney injury. Previous reports regarding WRN included few Asian patients who might have differed from the western WRN patients in terms of genetic and environmental factors.MethodsDuring the period of March 2003 to December 2011, the data about a total of 1297 patients who had serum creatinine (sCr) level measured within 1 week after INR >3.0 and within 6 months before INR >3.0 was analyzed through the retrospective review of electronic medical records of a single tertiary hospital in Korea.ResultWRN developed in 19.3% of patients having excessive warfarinization. The incidence was higher in the chronic kidney disease (CKD) group than the non-CKD group. The risk of WRN increased as the basal serum albumin level decreased and was strongly associated with highest quartile serum AST level at post INR elevation and the presence of congestive heart failure. But the presence of atrial fibrillation was protective against the development of WRN. Neither the presence of CKD nor basal estimated glomerular filtration rate (eGFR) was an independent risk factor for WRN. Despite no difference in the basal sCr level, the sCr level was higher in patients with WRN than those without WRN after follow-up. The mortality rates were also higher in patients with WRN.ConclusionsWRN developed in 19.3% of patients having excessive warfarinization. A lower basal serum albumin, highest quartile serum AST level at post INR elevation, and congestive heart failure were associated with the occurrence of WRN. The development of WRN adversely affected renal and patient outcomes.
Highlights
Warfarin, the most commonly prescribed oral anticoagulant, interrupts the synthesis of coagulation factors (II, VII, IX, and X) by inhibiting the C1 subunit of the vitamin K epoxide reductase enzyme complex and causes disruption of the extrinsic clotting cascade [1,2].Warfarin-related nephropathy (WRN) is a recently described disease entity, in which excessive warfarinization [international normalized ratio (INR) .3.0] causes acute kidney injury without the evidence of clinically relevant hemorrhage [3]
WRN developed in 19.3% of patients having excessive warfarinization
A lower basal serum albumin, highest quartile serum AST level at post INR elevation, and congestive heart failure were associated with the occurrence of WRN
Summary
Warfarin-related nephropathy (WRN) is a recently described disease entity, in which excessive warfarinization [international normalized ratio (INR) .3.0] causes acute kidney injury without the evidence of clinically relevant hemorrhage [3]. The fact that a multitude of different environmental factors, including diet and drugs, and genetics can affect the pharmacokinetics and pharmacodynamics of warfarin [7,8] suggests the need to perform studies on WRN in different. Warfarin-related nephropathy (WRN) is a recently described disease entity, in which excessive warfarinization (international normalized ratio (INR) .3.0) causes acute kidney injury. Previous reports regarding WRN included few Asian patients who might have differed from the western WRN patients in terms of genetic and environmental factors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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
