We read with interest the well-written meta-analysis by Adamou et al. [1], focused on studies of atrial fibrillation (AF) patients, investigating the comparative effect of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) on kidney function outcomes, namely 1) glomerular filtration rate decline of at least 30 % compared to baseline, 2) progression to end-stage renal disease (ESRD) or the need for hemodialysis, and 3) doubling of serum creatinine. The authors conducted a well-performed search procedure to select 13 studies (12 observational and a sub-analysis of a randomized trial) with over 300,000 patients.
