Urinary markers of kidney damage in patients with atrial fibrillation and chronic kidney disease receiving rivaroxaban: a prospective observational study

Shatalova N.: Russian Medical Academy of Continuous Professional Education

Ostroumova O.D.: Russian Medical Academy for Continuing Professional Education, Moscow

Mirzaev K.B.: Russian Medical Academy of Continuous Professional Education

Kochetkov A.I.: Russian Medical Academy of Continuous Professional Education

Ebzeeva E.Yu.: Russian Medical Academy of Continuous Professional Education

Starodubova A.V.: Federal Research Centre of Nutrition and Biotechnology. Pirogov Russian National Research Medical University, Moscow, Russia

Korotkova T.N.: Federal Research Centre of Nutrition and Biotechnology

Vorozhko I.V.: Federal Research Centre of Nutrition and Biotechnology

Klychnikova E.V.: Sklifosovsky Research Institute For Emergency Medicine

Godkov M.A.: Russian Medical Academy of Continuous Professional Education. Sklifosovsky Research Institute For Emergency Medicine

Sychev D.A.: Russian Medical Academy of Continuing Professional Education

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Summary

Aim

To assess the urinary markers of podocytic (nephrin) and tubulointerstitial damage (NGAL, KIM-1, albuminuria) levels in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) stages 3 and 4 and to evaluate their relationship with bleedings during rivaroxaban treatment.

Material and methods

Urinary nephrin, NGAL, KIM 1 and albumin were measured in 133 patients aged 52 to 97 years (median age 82) with AF and CKD stages 3 and 4 and 45 healthy volunteers. Over 16-week follow-up, we evaluated the occurrence of bleedings.

Results

Median urnary nephrin and NGAL levels in patients with AF and CKD C3а (0.82 and 5.00 ng/mL, respectively) and CKD С3b,4 (0.56 and 5.05 ng/mL) were significantly higher than in healthy volunteers (0.24 and 2.62 ng/mL; р<0.001 for both comparisons). Median urinary KIM-1 level in patients with AF and CKD С3b,4 (0.53 ng/mL) was also higher than in the control group (0.21 ng/mL, р=0.042). NGAL and KIM-1 levels in patients who developed bleeding within 16 weeks of follow-up (7.07 and 0.67 ng/mL, respectively) were significantly higher than in patients without hemorrhagic complications (4.00 ng/mL, р=0.037 and 0.37 ng/mL, р=0.016).

Conclusion

In patients with AF, CKD and its severity were associated with higher urinary markers levels of tubular (KIM-1 and NGAL) and podocytic (nephrine) damage in urine. In patients with AF and concomitant CKD who developed bleedings during treatment with rivaroxaban, the KIM-1 and NGAL urinary levels at the inclusion visit were significantly higher than in patients without bleedings.

Key words

Atrial fibrillation, chronic kidney disease, bleeding, rivaroxaban, nephrin, NGAL, KIM-1.