A real-world exploration into clinical outcomes of direct oral anticoagulant therapy in people with chronic kidney disease: a large hospital-based study
A real-world exploration into clinical outcomes of direct oral anticoagulant therapy in people with chronic kidney disease: a large hospital-based study
Background: there is limited evidence to support definite clinical outcomes of direct oral anticoagulant (DOAC) therapy in chronic kidney disease (CKD). By identifying the important variables associated with clinical outcomes following DOAC administration in patients in different stages of CKD, this study aims to assess this evidence gap.
Methods: an anonymised dataset comprising 97,413 patients receiving DOAC therapy in a tertiary health setting was systematically extracted from the multidimensional electronic health records and prepared for analysis. Machine learning classifiers were applied to the prepared dataset to select the important features which informed covariate selection in multivariate logistic regression analysis.
Results: for both CKD and non-CKD DOAC users, features such as length of stay, treatment days, and age were ranked highest for relevance to adverse outcomes like death and stroke. Patients with Stage 3a CKD had significantly higher odds of ischaemic stroke (OR 2.45, 95% Cl: 2.10–2.86; p = 0.001) and lower odds of all-cause mortality (OR 0.87, 95% Cl: 0.79–0.95; p = 0.001) on apixaban therapy. In patients with CKD (Stage 5) receiving apixaban, the odds of death were significantly lowered (OR 0.28, 95% Cl: 0.14–0.58; p = 0.001), while the effect on ischaemic stroke was insignificant.
Conclusions: a positive effect of DOAC therapy was observed in advanced CKD. Key factors influencing clinical outcomes following DOAC administration in patients in different stages of CKD were identified. These are crucial for designing more advanced studies to explore safer and more effective DOAC therapy for the population. Graphical Abstract: (Figure presented.)
Chronic kidney disease, Decision trees, Direct oral anticoagulants (DOACs), Electronic health records (EHR)
Nwanosike, Ezekwesiri Michael
cfa7e99a-976a-43c3-8c46-00669d8e5da4
Merchant, Hamid A.
16e7d300-a50c-480f-99f5-86e30e9274ec
Sunter, Wendy
c667654f-5551-4aba-8d32-a24b96eebbe1
Ansari, Muhammad Ayub
7852fd5f-d9a8-4113-911a-533476958966
Conway, Barbara R.
2c87aa00-8c01-480c-befb-6092900011c9
Hasan, Syed Shahzad
e402cff7-ef4d-431e-8b82-905d3c8cfb89
2 April 2024
Nwanosike, Ezekwesiri Michael
cfa7e99a-976a-43c3-8c46-00669d8e5da4
Merchant, Hamid A.
16e7d300-a50c-480f-99f5-86e30e9274ec
Sunter, Wendy
c667654f-5551-4aba-8d32-a24b96eebbe1
Ansari, Muhammad Ayub
7852fd5f-d9a8-4113-911a-533476958966
Conway, Barbara R.
2c87aa00-8c01-480c-befb-6092900011c9
Hasan, Syed Shahzad
e402cff7-ef4d-431e-8b82-905d3c8cfb89
Nwanosike, Ezekwesiri Michael, Merchant, Hamid A., Sunter, Wendy, Ansari, Muhammad Ayub, Conway, Barbara R. and Hasan, Syed Shahzad
(2024)
A real-world exploration into clinical outcomes of direct oral anticoagulant therapy in people with chronic kidney disease: a large hospital-based study.
Journal of Nephrology.
(doi:10.1007/s40620-024-01930-x).
Abstract
Background: there is limited evidence to support definite clinical outcomes of direct oral anticoagulant (DOAC) therapy in chronic kidney disease (CKD). By identifying the important variables associated with clinical outcomes following DOAC administration in patients in different stages of CKD, this study aims to assess this evidence gap.
Methods: an anonymised dataset comprising 97,413 patients receiving DOAC therapy in a tertiary health setting was systematically extracted from the multidimensional electronic health records and prepared for analysis. Machine learning classifiers were applied to the prepared dataset to select the important features which informed covariate selection in multivariate logistic regression analysis.
Results: for both CKD and non-CKD DOAC users, features such as length of stay, treatment days, and age were ranked highest for relevance to adverse outcomes like death and stroke. Patients with Stage 3a CKD had significantly higher odds of ischaemic stroke (OR 2.45, 95% Cl: 2.10–2.86; p = 0.001) and lower odds of all-cause mortality (OR 0.87, 95% Cl: 0.79–0.95; p = 0.001) on apixaban therapy. In patients with CKD (Stage 5) receiving apixaban, the odds of death were significantly lowered (OR 0.28, 95% Cl: 0.14–0.58; p = 0.001), while the effect on ischaemic stroke was insignificant.
Conclusions: a positive effect of DOAC therapy was observed in advanced CKD. Key factors influencing clinical outcomes following DOAC administration in patients in different stages of CKD were identified. These are crucial for designing more advanced studies to explore safer and more effective DOAC therapy for the population. Graphical Abstract: (Figure presented.)
Text
s40620-024-01930-x
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More information
Accepted/In Press date: 9 March 2024
Published date: 2 April 2024
Keywords:
Chronic kidney disease, Decision trees, Direct oral anticoagulants (DOACs), Electronic health records (EHR)
Identifiers
Local EPrints ID: 488964
URI: http://eprints.soton.ac.uk/id/eprint/488964
PURE UUID: 58496e3e-45de-4496-9f06-15f916a04063
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Date deposited: 10 Apr 2024 16:30
Last modified: 11 Apr 2024 02:08
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Contributors
Author:
Ezekwesiri Michael Nwanosike
Author:
Hamid A. Merchant
Author:
Wendy Sunter
Author:
Muhammad Ayub Ansari
Author:
Barbara R. Conway
Author:
Syed Shahzad Hasan
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