Abstract 4369641: The impact of renal injury markers on bleeding risk in chronic kidney disease and atrial fibrillation patients receiving rivaroxaban

In patients with chronic kidney disease (CKD), the presence of concomitant atrial fibrillation (AF) increases both the risk of thromboembolic complications and the risk of bleeding associated with the use of antithrombotic drugs. The risk of these complications is especially high in elderly and senile individuals. Currently, a number of markers of kidney damage have been identified, but the relationship between the level of their excretion in urine and the presence of bleeding in patients with CKD and AF receiving anticoagulants has not been sufficiently studied. The aim of this study was to evaluate the possible relationship between the presence of bleeding in patients with CKD stages C3–4 and AF receiving rivaroxaban and the level of renal damage markers in urine. The study included 266 patients aged 65-97 years: 140 patients with AF and CKD C3a and 126 patients with AF in combination with CKD C3b and C4. Patients took rivaroxaban at a dosage of 15 mg or 20 mg once a day, depending on the glomerular filtration rate. All patients underwent a retrospective assessment of the presence of bleeding according to the HAS-BLED scale, analysis of the excretion of markers of renal injury (albumin; nephrin; neutrophil gelatinase-associated lipocalin (NGAL); kidney injury molecule-1 (KIM-1)) with urine. Additionally, an analysis of the level of markers of renal damage in the urine of 90 healthy volunteers was performed. According to the risk of bleeding, patients were divided into 2 groups: Group 1 included patients with ≥1 point (92 patients), average age 80.7 years). Group 2 included patients with 0 points: 174 patients, average age 78.2 years. Of the bleeding, bruises were common in 52 patients (19%), nosebleeds were found in 22 patients (8.3%), bleeding from minor wounds was noted in 12 patients (4.3%), muscle hematomas were found in 6 patients (2.2%), bleeding from the oral cavity was found in 6 patients (2.2%), and hemorrhoidal bleeding was diagnosed in 2 patients (0.75%). The levels of NGAL and KIM-1 in urine in patients with AF and CKD in group 1 (5.6 ng/ml and 0.69 ng/ml, respectively) were statistically significantly higher compared to patients in group 2 (4.2 ng/ml (p=0.039) and 0.39 ng/ml (p=0.019, Table 1). Our study results indicate the presence of a statistically significant association between the presence of bleeding in patients with AF and CKD stages 3–4 receiving rivaroxaban with the level of tubular damage markers KIM-1 and NGAL in urine.