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[Cardiovascular drugs and renal function: Pitfall of renal adaptation]

Nicolas Keller1, Marie Ruppert2, Marion Fourtage2

  • 1Service de néphrologie-dialyse, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.

Nephrologie & Therapeutique
|March 5, 2019
PubMed

Insights

The Cockcroft and Gault formula is not widely used for cardiovascular drug dose adjustments in France, despite recommendations. Current practices in the Vidal database suggest a need to update renal function assessment methods for chronic kidney disease patients.

Area of Science:

  • Pharmacology
  • Nephrology
  • Drug Safety

Background:

  • Chronic kidney disease (CKD) frequently necessitates cardiovascular drug use.
  • French health authorities recommend the Cockcroft and Gault formula for CKD drug dosage adjustments.
  • This recommendation is based on the perceived prevalence of this formula in the Vidal drug database.

Purpose of the Study:

  • To systematically review the Vidal drug database for recommended renal function assessment methods.
  • To evaluate the actual usage of the Cockcroft and Gault formula for cardiovascular drug dose adjustments.

Main Methods:

  • Systematic review of Vidal drug database files and Summary of Product Characteristics (SPCs) for cardiovascular drugs (ATC codes B01 and C).
  • Classification of identified drugs based on recommended renal function evaluation methods for dose adjustment.

Main Results:

  • 196 molecules were analyzed; 62.6% required renal function-based dose adjustment.
  • Creatinine clearance was the most frequent method (35.5%), often unspecified regarding estimation or measurement.
  • The Cockcroft and Gault formula was explicitly mentioned in only 3.9% of cases, rising to 8.4% when considering literature references.

Conclusions:

  • The widespread recommendation of the Cockcroft and Gault formula for dose adjustment in CKD appears unjustified based on Vidal database content.
  • Current recommendations for pharmacokinetic studies and renal function assessment in drug dose adjustments require revision.
Abstract

Keywords:
Cardiovascular drugsChronic kidney diseaseDrug dosageDébit de filtration glomérulaireGlomerular filtration rateHaute Autorité de santéInsuffisance rénale chroniqueMédicaments à visée cardiovasculairePosologie médicamenteuse

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