title: Cardiovascular Drugs and Metformin Drug Dosage According to Renal Function in Non-Institutionalized Elderly Patients.
abstract: Adaptation of drug dosage to kidney function is a common problem in general practice. The aim was to describe adaptation of cardiovascular drugs and metformin according to renal function and its association with mortality with regard to metformin in a cohort of elderly patients. This was an ancillary study to the S.AGES cohort made up of patients over 65 years of age managed by their general practitioner under real-life conditions and followed up prospectively for 3 years. The medications studied were digoxin, spironolactone and metformin. Adaptation of their daily dose according to renal function (eGFR according to CKD/EPI) was compared to that recommended in the summaries of product characteristics (SPCs) or international scientific societies (ISS). A total of 900 patients were included, including 588 on metformin. At baseline, dose adjustment according to renal function was 100% and 87.6% (95% CI: 82.6-92.6) for patients on digoxin and spironolactone respectively. For metformin, only 71.3% (95% CI: 67.6-74.9) or 78.1% (95% CI: 74.7-81.4) of patients had their dosage adapted at inclusion according to their renal function depending on whether the SPCs or ISS recommendations were considered. During the 3-year follow-up period, 42/588 patients died (none from lactic acidosis). At inclusion, a metformin dosage not adapted for renal function according to ISS was not associated with an increase in all-cause mortality (OR 1.7; 95% CI 0.6-5.0, p = 0.32). In conclusion, approximately one-quarter of elderly patients treated with metformin do not have their dosage adapted for renal function according to ISS although there is no increase in mortality after follow-up for 3 years.
authors.affiliation: Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris-Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, INSERM Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Becquemont
authors.affiliation: Endocrinology Department, Hôpital Bégin, Saint-Mandé, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bauduceau
authors.affiliation: Medical Director of ORPEA/CLINEA, Puteaux, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Benattar-Zibi
authors.affiliation: Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris-Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, INSERM Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Al-Salameh
authors.affiliation: Clinical Gerontology, CHU, 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: Department of Psychiatry, Faculty of Medicine Paris-Sud, INSERM U 669, University Paris-Sud, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Corruble
authors.affiliation: HEGP, Coronary Diseases, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Cardiovascular Functional Exploration, Louis Pradel Hospital, Hospices Civils de Lyon, 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: Biostatistics Department, Faculty of Medicine Paris-Sud, INSERM U 669, University Paris-Sud, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, 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, University Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.affiliation: INSERM U1171, Université de Lille, CHU, Lille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.affiliation: Endocrinology, Diabetes and Diseases of Nutrition (Pôle NUDE), University Hospital of Strasbourg and the 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, University Paris-Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, INSERM Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Piedvache
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005919:Glomerular Filtration Rate; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008687:Metformin / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D008687:Metformin