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Warfarin related nephropathy; Evidence Based Medicine

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Wisit Cheungpasitporn
Wisit Cheungpasitporn

Evidence base in Warfarin related nephropathy

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Warfarin Related Nephropathy: Evidence Based Medicine Wisit Cheungpasitporn, MD. PGY -2, Internal Medicine
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[object Object],[object Object],[object Object],[object Object],Thin basement membrane disease and acute renal failure secondary to gross hematuria and tubular necrosis Am J Kidney Dis. 2000 Mar;35(3):533-6.
 
 
[object Object],Warfarin Related Nephropathy?
Warfarin and AIN ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Warfarin and AIN
CONCLUSIONS: Overanticoagulation is  associated  with faster  progression  of CKD in a high percentage of patients. Our results indicate the need for prospective trials. Nevertheless, we suggest that our findings are sufficiently compelling at this point to justify extra caution in  warfarin -treated CKD patients to avoid overanticoagulation. 37% of CKD pts with elevated INR developed elevated Cr
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Methods ,[object Object],[object Object]
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Methods ,[object Object],[object Object]
Statistical Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Statistical Methods ,[object Object],[object Object]
Results ,[object Object]
Results ,[object Object],[object Object],[object Object]
Results ,[object Object]
Figure 1 4.44 4.15 4.57 4.13 4.22 4.22 2.75±1.65 1.17±0.71 1.80±1.24 1.13±0.67 P <0.0001 2.45±1.57 1.01±0.49 P <0.0001 1.52±1.08 1.00±0.51 3.25±1.67 1.79±1.09 P <0.0001 2.29±1.33 1.65±0.94
Figure 2
Figure 3 eGFR calculated by CKD-EPI Creatinine Equation
Results ,[object Object]
 
 
Hematuria and WRN Figure 4
Results ,[object Object]
 
[object Object],Results
Figure 5 73% 58% P<0.001 81.1% 68.9% P= 0.049 P=0.064 3.65, 95% CI 2.81-4.75 Non-significant levels 6months Controlling for covariates; age, CKD, DM, heart falure, GN 3.19, 95% CI 2.45-4.15 Hazard ratio for death
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Limitation ,[object Object],[object Object],[object Object]
Summary ,[object Object]
Implications for practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implications for research ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RIFLE vs. AKIN criteria ,[object Object],[object Object]
AKIN Criteria
 
Special Thanks to: ,[object Object],[object Object]
eGFR calculated by CKD-EPI Creatinine Equation

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Warfarin related nephropathy; Evidence Based Medicine

  • 1. Warfarin Related Nephropathy: Evidence Based Medicine Wisit Cheungpasitporn, MD. PGY -2, Internal Medicine
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  • 9. CONCLUSIONS: Overanticoagulation is  associated  with faster  progression  of CKD in a high percentage of patients. Our results indicate the need for prospective trials. Nevertheless, we suggest that our findings are sufficiently compelling at this point to justify extra caution in  warfarin -treated CKD patients to avoid overanticoagulation. 37% of CKD pts with elevated INR developed elevated Cr
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  • 24. Figure 1 4.44 4.15 4.57 4.13 4.22 4.22 2.75±1.65 1.17±0.71 1.80±1.24 1.13±0.67 P <0.0001 2.45±1.57 1.01±0.49 P <0.0001 1.52±1.08 1.00±0.51 3.25±1.67 1.79±1.09 P <0.0001 2.29±1.33 1.65±0.94
  • 26. Figure 3 eGFR calculated by CKD-EPI Creatinine Equation
  • 27.
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  • 30. Hematuria and WRN Figure 4
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  • 32.  
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  • 34. Figure 5 73% 58% P<0.001 81.1% 68.9% P= 0.049 P=0.064 3.65, 95% CI 2.81-4.75 Non-significant levels 6months Controlling for covariates; age, CKD, DM, heart falure, GN 3.19, 95% CI 2.45-4.15 Hazard ratio for death
  • 35.
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  • 46. eGFR calculated by CKD-EPI Creatinine Equation