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To investigate the association between CrCl and the risk of clinical adverse events and compare the safety profiles of vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC). Patients with newly diagnosed AF (&lt;\u20093 months before baseline visit) were collected from the prospective Global Registry on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) registry Phase III. Clinical events assessed included the composite outcome (all-cause death, thromboembolism, and major bleeding), cardiovascular (CV) death, myocardial infarction (MI), and other single outcomes. 10,594 AF patients (mean age 70.35\u2009\u00b1\u20099.92 years; 55% male; 73% on NOAC) were included. Increasing CrCl was associated with decreased risks of all cause death, composite outcomes and CV-death with in patients with CrCl\u2009&lt;\u200980 mL\/min. Multivariate Cox models indicated that compared to VKA, NOAC was associated with lower risks of all cause death (adjusted hazard ratio [aHR] 0.68, 95% CI 0.58\u20130.78), composite outcomes (aHR 0.77, 95% CI 0.69\u20130.86), CV-death (aHR 0.70, 95% CI 0.56\u20130.87), and major bleeding (aHR 0.74, 95% CI 0.61\u20130.91) in AF patients. For CrCl\u2009&lt;\u200930 mL\/min, lower risks of all-cause death, composite outcomes and CV death were related to NOAC therapy. In this large prospective global registry, NOACs were associated with better outcomes compared with VKA for patients with normal or impaired renal function.<\/jats:p>\n          <jats:p>\n            <jats:bold>Graphical abstract<\/jats:bold>\n          <\/jats:p>","DOI":"10.1007\/s11239-025-03067-5","type":"journal-article","created":{"date-parts":[[2025,2,9]],"date-time":"2025-02-09T18:51:01Z","timestamp":1739127061000},"page":"165-177","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Renal function and adverse clinical events in anticoagulated patients with atrial fibrillation: insights from the GLORIA-AF Registry Phase III"],"prefix":"10.1007","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4430-3452","authenticated-orcid":false,"given":"Yang","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven Ho Man","family":"Lam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio Francesco","family":"Romiti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bi","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tze Fan","family":"Chao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Olshansky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kui","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menno V.","family":"Huisman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. 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The study protocol was approved by local institutional review boards at each participating centre. The study was conducted according to the Good Clinical Practice and the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The Authors declares that there is no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"YL was an honorary associate research fellow at the University of Liverpool and was funded by Professor Kui Hong\u2019s national key research and development project in the Second Hospital of Nanchang University and Nanchang University Abroad Scholarship. GFR reports consultancy for Boehringer Ingelheim and an educational grant from Anthos. TFC reports honoraria for lectures from Boehringer Ingelheim, Bayer, Pfizer, and Daiichi Sankyo, outside the submitted work. MVH reports receiving research grants from the Dutch Healthcare Fund, Dutch Heart Foundation, BMS-Pfizer, Bayer Healthcare and Boehringer Ingelheim and consulting fees from BMS-Pfizer, Bayer Healthcare and Boehringer Ingelheim to the institution. GYHL is the consultant and speaker for BMS\/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos. No fees are received personally. He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement No 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement No 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No 101080189), which are all funded by the EU\u2019s Horizon Europe Research & Innovation programme. Other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}