title: The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in korean patients.
abstract: BACKGROUND
  Warfarin-related nephropathy (WRN) is a recently described disease entity, in which excessive warfarinization (international normalized ratio (INR) >3.0) causes acute kidney injury. Previous reports regarding WRN included few Asian patients who might have differed from the western WRN patients in terms of genetic and environmental factors.
  
  
  METHODS
  During the period of March 2003 to December 2011, the data about a total of 1297 patients who had serum creatinine (sCr) level measured within 1 week after INR >3.0 and within 6 months before INR >3.0 was analyzed through the retrospective review of electronic medical records of a single tertiary hospital in Korea.
  
  
  RESULTS
  WRN developed in 19.3% of patients having excessive warfarinization. The incidence was higher in the chronic kidney disease (CKD) group than the non-CKD group. The risk of WRN increased as the basal serum albumin level decreased and was strongly associated with highest quartile serum AST level at post INR elevation and the presence of congestive heart failure. But the presence of atrial fibrillation was protective against the development of WRN. Neither the presence of CKD nor basal estimated glomerular filtration rate (eGFR) was an independent risk factor for WRN. Despite no difference in the basal sCr level, the sCr level was higher in patients with WRN than those without WRN after follow-up. The mortality rates were also higher in patients with WRN.
  
  
  CONCLUSIONS
  WRN developed in 19.3% of patients having excessive warfarinization. A lower basal serum albumin, highest quartile serum AST level at post INR elevation, and congestive heart failure were associated with the occurrence of WRN. The development of WRN adversely affected renal and patient outcomes.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jung Nam
authors.initials: JN
authors.lastname: An
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Ahn
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Yoon
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.forename: Sejoong
authors.initials: S
authors.lastname: Kim
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Na
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Chae
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications / Q000208:ethnology / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D044466:Asian People; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000208:ethnology / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000150:complications / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D012709:Serum Albumin; D014859:Warfarin; D003404:Creatinine
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