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Enhanced Nutritional Support May Ameliorate Rivaroxaban-Related Rapid Renal Function Decline: New Insights from a Real-World Study

Year: 2025

Type: article

Abstract: Aim: Aim to compare the effects of rivaroxaban and warfarin on rapid renal function decline. Methods: 8842 patients from the Tianjin Health and Medical Data Platform, with a 2.3 years median follow-up (interquartile range,1.5– 3.4), were assigned to either the warfarin group (n = 3913) or rivaroxaban group (n = 4929). Logistic models, inverse probability of treatment weighting(IPTW), and propensity score-matched (PSM) analyses were employed to compare the risk of rapid renal function decline associated with rivaroxaban versus warfarin. The multivariable fractional polynomial interaction(MFPI) was used to investigate interactions between continuous variables and the adverse outcome. Restricted cubic splines(RCS) were applied to assess the relationship between the prognostic nutritional index (PNI) score and the adverse outcome. Results: Rivaroxaban was associated with an increased risk of rapid renal function decline compared with warfarin in both the univariate (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.14– 1.36; P < 0.001) and multivariate (OR, 1.17; 95% CI, 1.07– 1.29; P = 0.001) logistic models. Similar trends were observed in the IPTW (OR, 1.16; 95% CI, 1.09– 1.33; P < 0.001), PSM model (OR, 1.21; 95% CI, 1.09– 1.33; P < 0.001), and all subgroup analyses. In the MFPI analysis, the adverse outcome was significantly alleviated with an increasing PNI score (threshold at PNI score of 50, P = 0.039). A linear negative relationship ( P for nonlinearity = 0.221) between the PNI score and rapid renal function decline was observed in patients receiving rivaroxaban. Conclusion: Rivaroxaban was associated with a higher risk of rapid renal function decline than warfarin. Enhanced nutritional support may help mitigate this adverse outcome. Keywords: rivaroxaban, warfarin, rapid renal function decline, nutritional support

Source: Drug Design Development and Therapy

DOI: 10.2147/dddt.s564100