title: Estimating kidney function and use of oral antidiabetic drugs in elderly.
abstract: The prevalence of diabetes mellitus (DM) and renal impairment rises with age making regular estimation of glomerular filtration rate (eGFR) in older diabetics necessary. This study investigated the differences among available estimating equations in assessing eGFR in older diabetics and examined the use of oral antidiabetic drugs (OADs) in relation to renal function. Patients with DM were participants of the Berlin Initiative Study (BIS), a population-based cohort study initiated in 2009 in Berlin, Germany, to evaluate kidney function in people ≥70 years. GFR was estimated with the creatinine-based CKD-EPICREA (Chronic Kidney Disease Epidemiology Collaboration), the MDRD (Modification of Diet in Renal Diseases) and the BIS1 equation and was directly measured (mGFR) with iohexol clearance as a gold standard in a subgroup (n = 137). Creatinine clearance was estimated with the Cockcroft-Gault equation (CrCl). DM prevalence was 26% (539 of 2070 overall participants). The antidiabetic drugs most commonly used among OAD patients were metformin (67%), glimepiride (27%) and glibenclamide (14%). Three of ten metformin patients had a CrCl <60 mL/min. Compared to mGFR, the mean differences of filtration rates calculated by MDRD, CKD-EPICREA and BIS1 were +8.9, +6.7 and -1.8 mL/min/1.73 m(2) , respectively. Summing up, many patients with a CrCl <60 mL/min received metformin, although this represents a contraindication in Germany. Glibenclamide was commonly used despite its classification as potentially inappropriate medication in older adults. Finally, BIS1 performed better in estimating GFR in older diabetics than MDRD or CKD-EPICREA .
authors.affiliation: Department of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.|Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany.
authors.forename: Antonios
authors.initials: A
authors.lastname: Douros
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Natalie
authors.initials: N
authors.lastname: Ebert
authors.affiliation: Institute for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Jakob
authors.affiliation: Institute for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.affiliation: Department of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kreutz
authors.affiliation: Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Schaeffner
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D005905:Glyburide / Q000008:administration & dosage; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D008954:Models, Biological; D011237:Predictive Value of Tests; D015995:Prevalence; D065667:Renal Elimination; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007004:Hypoglycemic Agents; D008687:Metformin; D003404:Creatinine; D005905:Glyburide
keywords: chronic kidney disease; elderly; measured glomerular filtration rate; metformin; oral antidiabetic drugs