Discrepancy Between Equations Estimating Kidney Function in Geriatric Care: A Study of Implications for Drug Prescription.
Journal
Drugs & aging
ISSN: 1179-1969
Titre abrégé: Drugs Aging
Pays: New Zealand
ID NLM: 9102074
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
pubmed:
7
12
2018
medline:
19
4
2019
entrez:
7
12
2018
Statut:
ppublish
Résumé
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 (eGFR 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 eGFR 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 eGFR 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 eGFR 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.
Sections du résumé
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 (eGFR
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 eGFR
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 eGFR
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 eGFR
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.
Identifiants
pubmed: 30519899
doi: 10.1007/s40266-018-0618-3
pii: 10.1007/s40266-018-0618-3
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
155-163Références
Nephrol Dial Transplant. 2007 Oct;22(10):2894-9
pubmed: 17575316
Kidney Int Suppl (2011). 2013 Jan;3(1):5-14
pubmed: 25598998
JAMA. 1963 Sep 21;185:914-9
pubmed: 14044222
BMJ Open. 2013 Apr 11;3(4):
pubmed: 23585393
Gerontology. 2009;55(3):288-95
pubmed: 19001785
Nephrol Dial Transplant. 2010 Feb;25(2):449-57
pubmed: 19793928
Drugs Aging. 2018 Jun;35(6):539-544
pubmed: 29736814
Pharmacotherapy. 2013 Sep;33(9):912-21
pubmed: 23625813
Kidney Int. 2011 Dec;80(11):1122-37
pubmed: 21918498
N Engl J Med. 2011 Nov 24;365(21):2002-12
pubmed: 22111719
BMJ Open. 2013 Sep 27;3(9):e003343
pubmed: 24078751
Am J Kidney Dis. 2013 Aug;62(2):245-52
pubmed: 23566637
Gerontology. 1999 Sep-Oct;45(5):243-53
pubmed: 10460985
Drugs Aging. 2009;26(7):595-606
pubmed: 19655826
JAMA. 2007 Nov 7;298(17):2038-47
pubmed: 17986697
Lancet. 1986 Feb 8;1(8476):307-10
pubmed: 2868172
Am J Kidney Dis. 2012 Nov;60(5):847-9
pubmed: 22938847
Nephrol Dial Transplant. 2011 Sep;26(9):2852-9
pubmed: 21292816
Ann Intern Med. 1999 Mar 16;130(6):461-70
pubmed: 10075613
J Am Soc Nephrol. 2005 Mar;16(3):763-73
pubmed: 15659562
Drugs Aging. 2011 May 1;28(5):379-90
pubmed: 21542660
J Gerontol A Biol Sci Med Sci. 2007 Nov;62(11):1300-5
pubmed: 18000152
Nat Rev Nephrol. 2014 Apr;10(4):193-207
pubmed: 24445744
Pharmacotherapy. 2010 Aug;30(8):776-86
pubmed: 20653353
Clin J Am Soc Nephrol. 2010 Jun;5(6):1003-9
pubmed: 20299365
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Nephron. 1976;16(1):31-41
pubmed: 1244564
Nephrol Dial Transplant. 2016 Nov;31(suppl 2):ii1-ii66
pubmed: 27807144
Nephrol Dial Transplant. 2011 Oct;26(10):3286-95
pubmed: 21677301
J Clin Epidemiol. 1994 Nov;47(11):1245-51
pubmed: 7722560