Kidney Function and Apixaban

Although patients with diminished kidney function are often prescribed the anticoagulant apixaban, a lower dose is recommended for those aged 80 years and older, weighing 60 kg or more, or with serum creatinine measuring 1.5 mg/dL or higher.

Research to be presented at the National Kidney Foundation Spring Clinical Meetings 2025 clarified the association between kidney function and apixaban pharmacokinetics, pharmacodynamics, and hemorrhage among the patients treated with the drug. The study followed up 1,697 patients treated with apixaban for up to 2 years. Forty percent of participants were Black and 48% were women. Of the full cohort, 34.1% had an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m², broken down as follows: 15.9% with eGFR 45 to 59.9 mL/min/1.73 m², 9.0% with eGFR 30 to 44.9 mL/min/1.73 m², and 9.1% with eGFR less than 30 mL/min/1.73 m². Seventy of the 155 patients with eGFR less than 30 mL/min/1.73 m² were receiving dialysis.

The overall hemorrhage rate was 10.8 per 100 person-years (95% CI, 9.5-12.2). The risk of hemorrhage did not vary by age and was 10.9 per 100 person-years for participants younger than 80 years and 10.1 per 100 person-years for those aged 80 or older. However, hemorrhage risk was higher among participants who weighed 60 kg or less compared with those weighing more than 60 kg (19.8 vs 10.5 per 100 person-years). The risk was also higher for those with lower eGFRs.

A 12-hour subgroup pharmacokinetic-pharmacodynamic analysis included 89 participants; 45% were Black and 45% were women. Eighteen subgroup patients had an eGFR of 60 mL/min/1.73 m² or greater; 18 had an eGFR of 45 to 59.9 mL/min/1.73 m²; 22 had an eGFR of 30 to 44.9 mL/min/1.73 m²; 10 had an eGFR less than 30 mL/min/1.73 m² (without dialysis); and 19 were receiving dialysis. The patients with eGFR less than 30 mL/min/1.73 m² (without dialysis) demonstrated greater systemic exposure to apixaban and corresponding anti-Xa activity.

In summary, the researchers found that impaired kidney function was the primary predictor of hemorrhage among patients treated with apixaban after accounting for clinical predictors. The findings suggest that kidney function should factor into risk prediction rules for hemorrhage and that a lower apixaban dose is appropriate for patients with eGFR below 30 mL/min/1.73 m² regardless of whether they are receiving dialysis.

Source: Limdi N, Dillon C, Davis B, et al. Influence of kidney function on apixaban pharmacokinetics, pharmacodynamics and hemorrhage. Abstract #LB-03. Presented at the National Kidney Foundation Spring Clinical Meetings 2025; April 10-13, 2025; Boston, MA.