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Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort.
- Source :
-
Aging clinical and experimental research [Aging Clin Exp Res] 2022 Mar; Vol. 34 (3), pp. 591-598. Date of Electronic Publication: 2021 Oct 18. - Publication Year :
- 2022
-
Abstract
- Background: Direct oral anticoagulants (DOACs) pharmacokinetics depends on estimated glomerular filtration rate (eGFR), whose estimation is crucial for optimal risk/benefit balance.<br />Aims: To assess the concordance among different eGFR formulas and the potential impact on DOACs prescription appropriateness and bleeding risk in oldest hospitalized patients.<br />Methods: Post hoc analysis of a single-centre prospective cohort study. eGFR was calculated by creatinine-based (MDRD, CKD-EPI <subscript>Cr</subscript> , BIS <subscript>1</subscript> ) and creatinine-cystatin-C-based (CKD-EPI <subscript>Comb</subscript> and BIS <subscript>2</subscript> ) formulas. Patients were stratified according to eGFR [severely depressed (SD) 15-29; moderately depressed (MD) 30-49; preserved/mildly depressed (PMD): ≥ 50 ml/min/1.73 m <superscript>2</superscript> ]. Concordance between the different equations was assessed by Cohen's kappa coefficient.<br />Results: Among AF patients, 841 (59.2% women, mean age 85.9 ± 6.5 years) received DOACs. By CKD-EPI <subscript>Cr</subscript> equation, 135 patients were allocated in the SD, 255 in the MD and 451 in the PMD group. The concordance was excellent only between BIS 2 and CKD-EPI <subscript>Comb</subscript> and MDRD and CKD-EPI <subscript>Cr</subscript> , while was worse (from good to poor) between the other formulas. Indeed, by adding cystatin-C almost over 1/3 of the patients were reallocated to a worse eGFR class. Bleeding prevalence increased by 2-3% in patients with discordant eGFR between formulas, reallocated to a worse chronic kidney disease (CKD) stage, although without reaching statistical significance. CKD-EPI <subscript>Comb</subscript> resulted the best predictor of bleeding events (AUROC 0.71, p = 0.03).<br />Discussion: This study highlights the variability in CKD staging according to different eGFR formulas, potentially determining inappropriate DOACs dosing. Although the cystatin-C derived CKDEPI <subscript>Comb</subscript> equation is the most accurate for stratifying patients, BIS <subscript>1</subscript> may represent a reliable alternative.<br /> (© 2021. The Author(s).)
Details
- Language :
- English
- ISSN :
- 1720-8319
- Volume :
- 34
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Aging clinical and experimental research
- Publication Type :
- Academic Journal
- Accession number :
- 34661901
- Full Text :
- https://doi.org/10.1007/s40520-021-01986-w