Document Detail


Warfarin therapy that results in an International Normalization Ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease.
MedLine Citation:
PMID:  20413993     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: We had previously reported that acute kidney injury (AKI) in warfarin-treated chronic kidney disease (CKD) patients may occur shortly after an acute increase in the International Normalization Ratio (INR) >3.0 with formation of occlusive red blood casts. Recovery from this warfarin-associated AKI is poor. Here we investigated whether excessive warfarin therapy could accelerate the progression of CKD.
METHODS: We analyzed serum creatinine (SC) and INR in 103 consecutive CKD patients on warfarin therapy in our Nephrology program from 2005 to the present.
RESULTS: Forty-nine patients experienced at least 1 episode of INR >3.0. Of these, 18 patients (37%, Group 1) developed an unexplained increase in SC > or =0.3 mg/dl coincident with INR >3.0 (mean SC increase 0.61 +/- 0.44 mg/dl); 31 patients (63%, Group 2) showed stable SC (mean SC change 0.04 +/- 0.19 mg/dl). Subsequent CKD progression was accelerated in Group 1, but not in Group 2. The 2 groups were not different with respect to demographics, comorbidities, blood pressure, or therapies. However, African Americans were overrepresented in Group 1 (p = 0.035).
CONCLUSIONS: Overanticoagulation is associated with faster progression of CKD in a high percentage of patients. Our results indicate the need for prospective trials. Nevertheless, we suggest that our findings are sufficiently compelling at this point to justify extra caution in warfarin-treated CKD patients to avoid overanticoagulation.
Authors:
Sergey V Brodsky; Michael Collins; Edward Park; Brad H Rovin; Anjali A Satoskar; Gyongyi Nadasdy; Haifeng Wu; Udayan Bhatt; Tibor Nadasdy; Lee A Hebert
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-04-22
Journal Detail:
Title:  Nephron. Clinical practice     Volume:  115     ISSN:  1660-2110     ISO Abbreviation:  Nephron Clin Pract     Publication Date:  2010  
Date Detail:
Created Date:  2010-06-10     Completed Date:  2011-02-18     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  101159763     Medline TA:  Nephron Clin Pract     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  c142-6     Citation Subset:  IM    
Copyright Information:
Copyright 2010 S. Karger AG, Basel.
Affiliation:
Department of Pathology, The Ohio State University, Columbus, OH 43210, USA. sergey.brodsky@osumc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cohort Studies
Creatinine / blood
Disease Progression*
Female
Humans
International Normalized Ratio* / trends
Male
Middle Aged
Renal Insufficiency, Chronic / blood*,  chemically induced,  drug therapy*
Retrospective Studies
Treatment Outcome
Warfarin / adverse effects*,  therapeutic use
Grant Support
ID/Acronym/Agency:
UL1 RR025755/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
60-27-5/Creatinine; 81-81-2/Warfarin
Comments/Corrections

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