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Discrepancy Between Equations Estimating Kidney Function in Geriatric Care: A Study of Implications for Drug Prescription

  • Florent Guerville
  • Claire Roubaud-Baudron
  • Sophie Duc
  • Nathalie Salles
  • Muriel Rainfray
  • Isabelle Bourdel-Marchasson
Short Communication

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.

Notes

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the conduct of this study or the preparation of this article.

Conflict of Interest

Florent Guerville, Claire Roubaud-Baudron, Sophie Duc, Nathalie Salles, Muriel Rainfray and Isabelle Bourdel-Marchasson declare that they have no conflicts of interest relevant to the content of this study.

Ethical approval

This study was conducted in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The database has been anonymized and protected. In view of the material available to it, our institutional ethics committee issued a favorable opinion for the publication of this research work (decision #CE-GP-2018/14).

Supplementary material

40266_2018_618_MOESM1_ESM.pdf (88 kb)
Electronic Supplementary Material Fig. S1. Comparison of Chronic Kidney Disease Epidemiology Collaboration-estimated glomerular filtration rate and Cockcroft-Gault-estimated creatinine clearance. Bland-Altman comparison of Chronic Kidney Disease Epidemiology Collaboration equation-based estimated glomerular filtration rate (eGFRCKD-EPI) and Cockcroft-Gault equation-based estimated creatinine clearance (eCrCl) at admission. Mean difference between results of the two equations (solid black line) ± 2 standard deviations (dashed black lines). Black dots represent patients receiving at least one drug whose recommended prescription (dose or contraindication) was different according to eCrCl and eGFRCKD-EPI adjustment. White dots represent patients receiving drugs whose recommended prescription was the same according to eCrCl and eGFRCKD-EPI. Difference (Y-axis) and mean (X-axis) of the two equation results were not correlated using a linear regression (r2 = 0.001, p = 0.7) (PDF 88 kb)
40266_2018_618_MOESM2_ESM.pptx (94 kb)
Supplementary material 2 (PPTX 94 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.CHU Bordeaux, Département de Gérontologie CliniquePessacFrance
  2. 2.Univ. BordeauxBordeauxFrance
  3. 3.Univ. Bordeaux, CNRS UMR 5536 RMSBBordeauxFrance

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