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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association between Cardiovascular Drugs and Chronic Kidney Disease in Non-Institutionalized Elderly Patients
Laurent Becquemont1, Bernard Bauduceau2, Linda Benattar-Zibi3
1Pharmacology Department, Faculty of Medicine Paris-Sud, APHP, Bicêtre university Hospital, University Paris-Sud, Le Kremlin Bicêtre, France.
Insights
Cardiovascular drugs are safe for elderly patients with chronic kidney disease (CKD). Real-world data show minimal impact on kidney function, supporting their use in older adults.
Area of Science:
- Nephrology
- Geriatrics
- Cardiology
Background:
- Renal safety concerns often limit cardiovascular drug use in the elderly.
- Elderly patients frequently have comorbidities like chronic kidney disease (CKD).
Purpose of the Study:
- To investigate the relationship between cardiovascular drugs and CKD in elderly individuals in a real-world setting.
- To assess the impact of commonly prescribed cardiovascular medications on renal function in older adults.
Main Methods:
- Ancillary study of the prospective S.AGE cohort.
- Included 2505 non-institutionalized patients aged 65+ with chronic pain, atrial fibrillation, or type 2 diabetes.
- Estimated glomerular filtration rate (eGFR) monitored annually for 2 years.
Main Results:
- At baseline, CKD (eGFR < 60 ml/min/1.73 m²) was associated with age, female gender, hypertension, heart failure, atherothrombotic disease, renin-angiotensin system blockers, loop diuretics, and calcium channel inhibitors.
- Introduction of these drug classes caused small eGFR decreases: -3.8±12.7 (RAS blockers), -2.2±12.0 (loop diuretics), -1.0±13.4 (CCBs).
- Only loop diuretics were significantly associated with CKD (OR 1.91, p=0.002).
Conclusions:
- Cardiovascular drug use in the elderly appears renal safe.
- Renal safety should not impede the use of beneficial cardiovascular medications in older patients.
Abstract:
Concern about the renal safety of commonly used cardiovascular drugs with demonstrated clinical benefit appears to be an obstacle to their use in the elderly. The objective was to describe the relationship between cardiovascular drugs and chronic kidney disease (CKD) in elderly individuals in the real-life setting. This is an ancillary study of the prospective non-interventional S.AGE (aged individuals) cohort. General physicians were free to prescribe any drug their patients needed. The participants were non-institutionalized patients aged 65 years and older treated by their primary physician for either chronic pain or atrial fibrillation or type 2 diabetes mellitus. The estimated glomerular filtration rate (eGFR) derived from the CKD-EPI formula was determined at inclusion and every year during 2 years of follow-up. This study comprised 2505 patients aged 77.8 ± 6.2 years. At inclusion, the factors associated with CKD (eGFR < 60 ml/min/1.73 m(2) ) in multivariate analysis were age, female gender, hypertension, heart failure, history of atherothrombotic disease and renin angiotensin system blockers, loop diuretics and calcium channel inhibitors. Introduction of each of these three drug classes during the follow-up period led to only a small decrease in the eGFR: -3.8 ± 12.7 (p < 0.0006), -2.2 ± 12.0 (p < 0.003) and -1.0 ± 13.4 ml/min./1.73 m(2) (NS), respectively. Only the introduction of loop diuretics was associated with CKD (OR 1.91, 95% CI: 1.25-2.90; p = 0.002). Renal safety of cardiovascular drugs in the elderly appears acceptable and should not be a barrier to their use.
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