• Raquel López-Gálvez, José Miguel Rivera-Caravaca, Manuel Anguita Sánchez, Marcelo Sanmartín Fernández, Carles Rafols, Pérez-CabezaAlejandro IsidoroAIDepartment of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain., Gonzalo Barón Esquivias, Iñaki Lekuona Goya, José Manuel Vázquez Rodríguez, Juan Cosín Sales, Arribas YnsaurriagaFernandoFDepartment of Cardiology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain., Vivencio Barrios, Román Freixa-Pamias, and Francisco Marín.
• Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.
• Eur. J. Clin. Invest. 2022 Sep 1; 52 (9): e13788.

BackgroundIn atrial fibrillation (AF) patients on vitamin K antagonists, a progressive deterioration of renal function is common but there is limited evidence with long-term use of rivaroxaban. Herein, we investigated the change in renal function in AF patients after 2 years of rivaroxaban treatment.MethodsThe EMIR registry is an observational and multicentre study including AF patients treated with rivaroxaban for at least 6 months prior to inclusion. Changes in analytical parameters were recorded during 2 years of follow-up. Renal function was estimated using the Cockroft-Gault equation.Results1433 patients (638, 44.5% women, mean age of 74.2 ± 9.7 years) were included. Creatinine clearance (CrCl) was available at baseline and at 2 years in 1085 patients. At inclusion, 33.2% of patients had impaired renal function (CrCl <60 ml/min). At 2 years, we were not able to find changes in the proportion of patients with impaired renal function, which increased to 34.6% (p = 0.290). However, the baseline mean CrCl was 76.0 ± 30.5 ml/min and slightly improved at 2 years (77.0 ± 31.8 ml/min; p = 0.014). Overall, the proportion of patients with CrCl <60 ml/min at baseline that had CrCl ≥60 ml/min at 2 years was significantly higher compared to that of patients with CrCl ≥60 ml/min at baseline and CrCl <60 ml/min after (22.2% vs. 13.1%; p < 0.001) CONCLUSIONS: In AF patients on long-term rivaroxaban therapy, a decrease in renal function was not observed. We even observed a slight improvement in the patients with renal impairment. These results reinforce the idea that rivaroxaban may be a safe option even in patients with renal impairment.© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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