Rivaroxaban vs. warfarin and renal outcomes in non-valvular atrial fibrillation patients with diabetes

Adrian V. Hernandez, George Bradley, Mohammad Khan, Andrew Fratoni, Anna Gasparini, Yuani M. Roman, Thomas J. Bunz, Daniel Eriksson, Anna Katharina Meinecke, Craig I. Coleman

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Aims: Vascular calcification is common in diabetic patients. Warfarin has been associated with renovascular calcification and worsening renal function; rivaroxaban may provide renopreservation by decreasing vascular inflammation. We compared the impact of rivaroxaban and warfarin on renal outcomes in diabetic patients with non-valvular atrial fibrillation (NVAF). Methods and results: Using United States IBM MarketScan data from January 2011 to December 2017, we identified adults with both NVAF and diabetes, newly-initiated on rivaroxaban or warfarin with ≥12-month insurance coverage prior to anticoagulation initiation. Patients with Stage 5 chronic kidney disease (CKD) or undergoing haemodialysis at baseline were excluded. Differences in baseline covariates between cohorts were adjusted using inverse probability-of-treatment weighting (IPTW) based on propensity scores (absolute standardized differences <0.1 achieved for all after adjustment). Outcomes included incidence rates of emergency department/hospital admissions for acute kidney injury (AKI) and the composite of the development of Stage 5 CKD or need for haemodialysis. Patients were followed until an event, index anticoagulant discontinuation/switch, insurance disenrollment, or end-of-data availability. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression. We assessed 10 017 rivaroxaban (22.6% received a reduced dose) and 11 665 warfarin users. In comparison to warfarin, rivaroxaban was associated with lower risks of AKI (HR = 0.83, 95% CI = 0.74-0.92) and development of Stage 5 CKD or need for haemodialysis (HR = 0.82, 95% CI = 0.70-0.96). Sensitivity and subgroup analyses had similar effects as the base-case analysis. Conclusion: Rivaroxaban appears to be associated with lower risks of undesirable renal outcomes vs. warfarin in diabetic NVAF patients.

Original languageEnglish
Pages (from-to)301-307
Number of pages7
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Issue number4
StatePublished - 1 Oct 2020


  • Diabetes mellitus
  • fibrillation
  • Non-valvular atrial
  • Renal outcomes
  • Rivaroxaban


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