1. Cardiovascular Drugs and Metformin Drug Dosage According to Renal Function in Non-Institutionalized Elderly Patients
- Author
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Florence Pasquier, Nicolas Danchin, Olivier Hanon, Jean Doucet, Sophie Bucher, Françoise Forette, Bernard Bauduceau, Linda Benattar-Zibi, Geneviève Derumeaux, Celine Piedvache, Gilles Berrut, Bruno Falissard, Abdallah Al-Salameh, Emmanuelle Corruble, Rissane Ourabah, Michel Pinget, Philippe Bertin, and Laurent Becquemont
- Subjects
Male ,medicine.medical_specialty ,Digoxin ,Renal function ,030204 cardiovascular system & hematology ,Pharmacology ,Kidney ,Toxicology ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Atrial Fibrillation ,medicine ,Humans ,Hypoglycemic Agents ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Cardiovascular Agents ,General Medicine ,medicine.disease ,Metformin ,Diabetes Mellitus, Type 2 ,chemistry ,Cohort ,Spironolactone ,Female ,France ,business ,Follow-Up Studies ,Glomerular Filtration Rate ,medicine.drug ,Cohort study - Abstract
Adaptation of drug dosage to kidney function is a common problem in general practice. The aim was to describe adaptation of cardiovascular drugs and metformin according to renal function and its association with mortality with regard to metformin in a cohort of elderly patients. This was an ancillary study to the S.AGES cohort made up of patients over 65 years of age managed by their general practitioner under real-life conditions and followed up prospectively for 3 years. The medications studied were digoxin, spironolactone and metformin. Adaptation of their daily dose according to renal function (eGFR according to CKD/EPI) was compared to that recommended in the summaries of product characteristics (SPCs) or international scientific societies (ISS). A total of 900 patients were included, including 588 on metformin. At baseline, dose adjustment according to renal function was 100% and 87.6% (95% CI: 82.6-92.6) for patients on digoxin and spironolactone respectively. For metformin, only 71.3% (95% CI: 67.6-74.9) or 78.1% (95% CI: 74.7-81.4) of patients had their dosage adapted at inclusion according to their renal function depending on whether the SPCs or ISS recommendations were considered. During the 3-year follow-up period, 42/588 patients died (none from lactic acidosis). At inclusion, a metformin dosage not adapted for renal function according to ISS was not associated with an increase in all-cause mortality (OR 1.7; 95% CI 0.6-5.0, p = 0.32). In conclusion, approximately one-quarter of elderly patients treated with metformin do not have their dosage adapted for renal function according to ISS although there is no increase in mortality after follow-up for 3 years.
- Published
- 2015