Apixaban may lower the risk for progression to a more advanced stage of chronic kidney disease (CKD) compared with warfarin, a new study suggests.

Using Medicare claims data from 2013-2017, investigators identified 12,816 patients (mean age 80 years; 51% female; 88% White) with stage 3 to 5 CKD and nonvalvular atrial fibrillation. Of the cohort, 50.3% were newly prescribed apixaban, a direct oral anticoagulant, and 49.7% were newly prescribed warfarin, a vitamin K antagonist.

Apixaban was associated with a 10% lower risk for CKD stage progression compared with warfarin, James B. Wetmore, MD, MS, of Hennepin Healthcare Research Institute in Minneapolis, Minnesota, and colleagues reported in the American Journal of Kidney Diseases. At baseline, 84% of patients had stage 3, 15% stage 4, and 1% stage 5 CKD. Apixaban was not associated with a lower risk for kidney failure compared with warfarin.

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According to Dr Wetmore’s team, “our results suggest that apixaban may be associated with superior long-term renal outcomes relative to warfarin in this population, but this cannot be definitively determined in the absence of data from clinical trials.”

Disclosure: This clinical trial was supported by Bristol-Myers Squibb and Pfizer. Please see the original reference for a full list of authors’ disclosures.


Wetmore JB, Yan H, Herzog CA, Weinhandl E, Reyes JL, Roetker NS. CKD progression in Medicare beneficiaries with nonvalvular atrial fibrillation treated with apixaban versus warfarin. Am J Kidney Dis. doi:10.1053/j.ajkd.2020.12.004