Abstract: FR-PO931

Impact of Age and Glomerular Filtration Rate on Cardiovascular Drug Use in CKD Patients

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Villain, Cédric, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
  • Stengel, Benedicte, Univ. Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
  • Massy, Ziad, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
  • Liabeuf, Sophie, CHU Amiens, Amiens, France
  • Metzger, Marie, Univ. Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
  • Combe, Christian, CHU de Bordeaux, Bordeaux, France
  • Fouque, Denis, CHU Lyon Sud, Pierre Benite, France
  • Frimat, Luc, CHRU Nancy-Brabois, Vandoeuvre les Nancy, France
  • Jacquelinet, Christian, Agence de la biomedecine, Saint-Denis La Plaine, France
  • Laville, Maurice, CHU Lyon Sud, Pierre Benite, France
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Evidence for prescribing cardiovascular drugs is low in elderly patients (pts) with chronic kidney disease (CKD). We analyzed the impact of age and glomerular filtration rate (GFR) on use of drugs recommended for several cardiovascular diseases (CVD) among pts with CKD.

Methods

We used baseline data from the CKD REIN cohort including 3033 adult pts with CKD stage 3-4. We studied use of several CVD-specific drugs according cardiovascular antecedents: antiplatelet agents, renin-angiotensin-aldosterone system (RAAS) blockers, beta-blockers, and statins or ezetimibe in coronary heart disease; antiplatelet agents or oral anticoagulant drugs (vitamin K antagonist or oral direct anticoagulant) in stroke or transient ischemic attack; oral anticoagulant drugs in atrial fibrillation with CHADS2-VASc2 score ≥2. Odds-ratios (OR) of drug use according to age and estimated GFR were adjusted for sex, educational, activities of daily living, and other CVD specific relevant confounders.

Results

Mean age was 66.8 yr, and mean CKD-EPI GFR 32.9 ml/min/1.73m2. Prevalence of coronary heart disease was 24.5% (81.3% of these pts were receiving antiplatelet agents, 75.7% RAAS blockers, 66.1% beta blockers, and 82.9% statins or ezetimibe), that of stroke or transient ischemic attack was 10.1% (88.3% pts receiving antiplatelet agents or oral anticoagulant drugs), and that of atrial fibrillation and CHADS2-VASc≥2 11.2% (69.0% receiving oral anticoagulant drugs). Results of logistic regression are shown in Table 1.

Conclusion

Although the management of CVD was appropriate in the majority of CKD patients, old age and to a lesser extend low eGFR were associated with underuse of certain recommended drugs. The cross-sectional design of our study, however, does not enable to show whether these drugs were never used or were discontinued due to side effect.

Funding

  • Commercial Support