title: Association between Cardiovascular Drugs and Chronic Kidney Disease in Non-Institutionalized Elderly 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.
authors.affiliation: Pharmacology Department, Faculty of Medicine Paris-Sud, APHP, Bicêtre university Hospital, University Paris-Sud, Le Kremlin Bicêtre, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Becquemont
authors.affiliation: Endocrinology Department, Bégin hospital, Saint-Mandé, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bauduceau
authors.affiliation: ORPEA/CLINEA, Puteaux, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Benattar-Zibi
authors.affiliation: Clinical Gerontology, Nantes university hospital, Nantes, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Berrut
authors.affiliation: Rheumatology Department, Limoges University Hospital, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertin
authors.affiliation: General Practice Department, Faculty of Medicine Paris-Sud, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bucher
authors.affiliation: INSERM U 669, Faculty of Medicine Paris-Sud, Department of Psychiatry, Bicêtre University Hospital, APHP, University Paris-Sud, Le Kremlin Bicêtre, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Corruble
authors.affiliation: Coronary Diseases, HEGP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Pharmacology Department, Faculty of Medicine Paris-Sud, APHP, Bicêtre university Hospital, University Paris-Sud, Le Kremlin Bicêtre, France.
authors.forename: Abdallah
authors.initials: A
authors.lastname: al-Salameh
authors.affiliation: Cardiovascular Functional Exploration, Louis Pradel Hospital, HCL, Bron, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Derumeaux
authors.affiliation: Internal Medicine, Geriatrics and Therapeutics, Saint Julien University Hospital, Rouen University, Rouen, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Doucet
authors.affiliation: INSERM U 669, Faculty of Medicine Paris-Sud, Biostatistics Department, APHP, Hôpital Paul Brousse, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.affiliation: National Foundation of Gerontology, University Paris Descartes, Paris, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Forette
authors.affiliation: Geriatrics Department, EA 4468, AP-HP, Broca university hospital, University Paris Descartes, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.affiliation: UDSL, EA 1046, CHU, University of Lille Nord de France, Lille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.affiliation: Endocrinology, Diabetes and Diseases of Nutrition, University Hospital of Strasbourg, European Centre for the Study of Diabetes (CeeD), University of Strasbourg, Strasbourg, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Pinget
authors.affiliation: General Practice Department, Faculty of Medicine Paris-Sud, University Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Rissane
authors.initials: R
authors.lastname: Ourabah
authors.affiliation: Pharmacology Department, Faculty of Medicine Paris-Sud, APHP, Bicêtre university Hospital, University Paris-Sud, Le Kremlin Bicêtre, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Piedvache
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy; D002317:Cardiovascular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D059350:Chronic Pain / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012737:Sex Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002317:Cardiovascular Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors