Florent Guerville1, Claire Roubaud-Baudron2,3, Sophie Duc2, Nathalie Salles2,3, Muriel Rainfray2,3, Isabelle Bourdel-Marchasson2,3,4. 1. CHU Bordeaux, Département de Gérontologie Clinique, Avenue du Haut-Lévêque, F-33604, Pessac, France. florent.guerville@chu-bordeaux.fr. 2. CHU Bordeaux, Département de Gérontologie Clinique, Avenue du Haut-Lévêque, F-33604, Pessac, France. 3. Univ. Bordeaux, F-33000, Bordeaux, France. 4. Univ. Bordeaux, CNRS UMR 5536 RMSB, F-33000, Bordeaux, France.
Abstract
BACKGROUND: In older patients, the agreement is low between creatinine clearance estimated with the Cockcroft-Gault equation (eCrCl) and glomerular filtration rate estimated with the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI). The implications of these discrepancies for drug prescription have so far been assessed only for a few selected molecules. OBJECTIVE: The aim of this study was to investigate the proportion of geriatric patients receiving drugs with a different recommended dose or indication (i.e. an adjustment discrepancy) depending on eCrCl versus eGFRCKD-EPI estimates of kidney function. METHODS: Patients admitted to acute geriatric care units in our university hospital were eligible for inclusion. All drug classes were studied. We retrospectively determined recommended prescriptions according to eCrCl and eGFRCKD-EPI. RESULTS: Sixty percent of patients received at least one drug requiring dose adjustment and/or received a drug with a relative contraindication based on their estimated kidney function. Thirty-one percent of patients received at least one drug with an adjustment discrepancy: 20% received at least one drug for which the recommended dose differed depending on eCrCl versus eGFRCKD-EPI estimates of kidney function, 4% received a drug with a relative contraindication according to eCrCl but not eGFRCKD-EPI, and 7% received both. Factors independently associated with an adjustment discrepancy were older age and lower weight. Main drug classes involved were benzodiazepines, anticoagulants, and anti-microbial drugs. CONCLUSION: In acute geriatric care units, recommended drug dose adjustments are frequently discordant according to the equations used to estimate kidney function, notably for benzodiazepines, anticoagulants, and anti-microbial drugs. The consequences for treatment efficacy and safety should be investigated.
BACKGROUND: In older patients, the agreement is low between creatinine clearance estimated with the Cockcroft-Gault equation (eCrCl) and glomerular filtration rate estimated with the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI). The implications of these discrepancies for drug prescription have so far been assessed only for a few selected molecules. OBJECTIVE: The aim of this study was to investigate the proportion of geriatric patients receiving drugs with a different recommended dose or indication (i.e. an adjustment discrepancy) depending on eCrCl versus eGFRCKD-EPI estimates of kidney function. METHODS:Patients admitted to acute geriatric care units in our university hospital were eligible for inclusion. All drug classes were studied. We retrospectively determined recommended prescriptions according to eCrCl and eGFRCKD-EPI. RESULTS: Sixty percent of patients received at least one drug requiring dose adjustment and/or received a drug with a relative contraindication based on their estimated kidney function. Thirty-one percent of patients received at least one drug with an adjustment discrepancy: 20% received at least one drug for which the recommended dose differed depending on eCrCl versus eGFRCKD-EPI estimates of kidney function, 4% received a drug with a relative contraindication according to eCrCl but not eGFRCKD-EPI, and 7% received both. Factors independently associated with an adjustment discrepancy were older age and lower weight. Main drug classes involved were benzodiazepines, anticoagulants, and anti-microbial drugs. CONCLUSION: In acute geriatric care units, recommended drug dose adjustments are frequently discordant according to the equations used to estimate kidney function, notably for benzodiazepines, anticoagulants, and anti-microbial drugs. The consequences for treatment efficacy and safety should be investigated.
Authors: Tomáš Bolek; Matej Samoš; Ingrid Škorňová; Lucia Stančiaková; Ján Staško; Peter Galajda; Peter Kubisz; Marián Mokáň Journal: Drugs Aging Date: 2018-06 Impact factor: 3.923
Authors: Lesley A Stevens; Christopher H Schmid; Yaping L Zhang; Josef Coresh; Jane Manzi; Richard Landis; Omran Bakoush; Gabriel Contreras; Saul Genuth; Goran B Klintmalm; Emilio Poggio; Peter Rossing; Andrew D Rule; Matthew R Weir; John Kusek; Tom Greene; Andrew S Levey Journal: Nephrol Dial Transplant Date: 2009-09-30 Impact factor: 5.992
Authors: Gary R Matzke; George R Aronoff; Arthur J Atkinson; William M Bennett; Brian S Decker; Kai-Uwe Eckardt; Thomas Golper; Darren W Grabe; Bertram Kasiske; Frieder Keller; Jan T Kielstein; Ravindra Mehta; Bruce A Mueller; Deborah A Pasko; Franz Schaefer; Domenic A Sica; Lesley A Inker; Jason G Umans; Patrick Murray Journal: Kidney Int Date: 2011-09-14 Impact factor: 10.612
Authors: Anders Helldén; Ingegerd Odar-Cederlöf; Göran Nilsson; Susanne Sjöviker; Anders Söderström; Mia von Euler; Gunnar Ohlén; Ulf Bergman Journal: BMJ Open Date: 2013-04-11 Impact factor: 2.692