Renal Function and 4-Year Outcomes in Edoxaban-Treated Patients: A Sub-Analysis From the ETNA-AF Europe Study.
5 affiliations
- 1University of Pisa and Pisa University Hospital, Pisa, Italy.
- 2Daiichi Sankyo Europe GmbH, Munich, Germany.
- 3Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- 4Institute of Molecular Biology and Genetics, Ariano Irpino, Italy.
- 5Association for Hypertension, Nephrology, and Kidney Transplant (IPNET), Nephrology, Great Metropolitan Hospital, Reggio Calabria, Italy.
Abstract
Background
Non-vitamin K oral anticoagulants, like edoxaban, are essential in managing atrial fibrillation (AF). The impact of renal function on edoxaban dosages in real-world settings remains unclear. This 4-year ETNA-AF-Europe study follow-up analysis investigated how chronic kidney disease (CKD) stages affect the safety and effectiveness of usual edoxaban doses.Methods
ETNA-AF-Europe (NCT02944019) was an observational study conducted from 2016 to 2022 across 776 centres in 10 European countries. Hazard ratios (HR) and annualized event rates were calculated for all-cause death, cardiovascular (CV) death, stroke and bleeding events for the overall population and participants stratified by dose (30/60 mg) and CKD stages at baseline.Results
Of the 13,164 participants in the full analysis set, 9114 participants with CKD (Stage 1, n = 2064; Stage 2, n = 4855; Stage 3, n = 1985; Stage 4, n = 135; missing, n = 75) received label-recommended edoxaban doses. Compared with CKD Stage 1, higher CKD stages were associated with increased risks for stroke (Stage 3: HR [95% CI]: 1.889 [1.240-2.878], p = 0.003) and CV death (HR [95% CI]; Stage 4: 14.450 [8.270-25.247], Stage 3: 4.672 [3.312-6.969], Stage 2: 2.066 [1.394-3.062], all p < 0.001). All-cause death followed a similar trend. After adjusting for age, sex, body weight, CHA₂DS₂-VASc and modified HAS-BLED scores, most bleeding and effectiveness outcomes showed no nominally significant differences across CKD stages.Conclusions
Edoxaban in patients with AF is effective and well tolerated across CKD stages and appropriate label dosing can offset the risk from renal impairment.
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BibTeX
@article{caterina2026renal,
title = {{Renal Function and 4-Year Outcomes in Edoxaban-Treated Patients: A Sub-Analysis From the ETNA-AF Europe Study.}},
author = {Raffaele De Caterina and Eva-Maria Fronk and Joana Nunes and Mathias Lamparter and Paulus Kirchhof and Carmine Zoccali and ETNA‐AF Europe Investigators},
journal = {European journal of clinical investigation},
year = {2026},
month = oct,
doi = {10.1111/eci.70268},
url = {https://europepmc.org/article/MED/42948863},
note = {CC BY},
}
RIS
TY - JOUR
TI - Renal Function and 4-Year Outcomes in Edoxaban-Treated Patients: A Sub-Analysis From the ETNA-AF Europe Study.
AU - Raffaele De Caterina
AU - Eva-Maria Fronk
AU - Joana Nunes
AU - Mathias Lamparter
AU - Paulus Kirchhof
AU - Carmine Zoccali
AU - ETNA‐AF Europe Investigators
PY - 2026
DA - 2026/10/28
JO - European journal of clinical investigation
DO - 10.1111/eci.70268
UR - https://europepmc.org/article/MED/42948863
AB - Background Non-vitamin K oral anticoagulants, like edoxaban, are essential in managing atrial fibrillation (AF). The impact of renal function on edoxaban dosages in real-world settings remains unclear. This 4-year ETNA-AF-Europe study follow-up analysis investigated how chronic kidney disease (CKD) stages affect the safety and effectiveness of usual edoxaban doses.Methods ETNA-AF-Europe (NCT02944019) was an observational study conducted from 2016 to 2022 across 776 centres in 10 European countries. Hazard ratios (HR) and annualized event rates were calculated for all-cause death, cardiovascular (CV) death, stroke and bleeding events for the overall population and participants stratified by dose (30/60 mg) and CKD stages at baseline.Results Of the 13,164 participants in the full analysis set, 9114 participants with CKD (Stage 1, n = 2064; Stage 2, n = 4855; Stage 3, n = 1985; Stage 4, n = 135; missing, n = 75) received label-recommended edoxaban doses. Compared with CKD Stage 1, higher CKD stages were associated with increased risks for stroke (Stage 3: HR [95% CI]: 1.889 [1.240-2.878], p = 0.003) and CV death (HR [95% CI]; Stage 4: 14.450 [8.270-25.247], Stage 3: 4.672 [3.312-6.969], Stage 2: 2.066 [1.394-3.062], all p < 0.001). All-cause death followed a similar trend. After adjusting for age, sex, body weight, CHA₂DS₂-VASc and modified HAS-BLED scores, most bleeding and effectiveness outcomes showed no nominally significant differences across CKD stages.Conclusions Edoxaban in patients with AF is effective and well tolerated across CKD stages and appropriate label dosing can offset the risk from renal impairment.
SN - 0014-2972
SN - 1365-2362
ER -