title: Oral antidiabetics use among diabetic type 2 patients with chronic kidney disease. Do nephrologists take account of recommendations?
abstract: BACKGROUND
  There is an increasing prevalence of diabetes type 2 and chronic kidney disease, challenging appropriate prescribing of oral anti-diabetic drugs (OADs).
  
  
  METHODS
  We have described the practice patterns of 13 nephrologists in 4 centers, in a cohort of 301 consecutive adult type 2 diabetic patients. Among oral anti-diabetic prescriptions, we have detailed drugs dosage for each subject, with 3 different formulae for estimating glomerular filtration rate (GFR) and its adequation according to the latest ERBP recommendations (2015). As individuals were mostly obese in this work, we also compare adequacy rates using both standard indexed CKD-EPI formula and CKD-EPI formula de-indexed from body surface area.
  
  
  RESULTS
  Using the CKD-EPI formula as the reference method for estimating GFR, 53.5% of patients were outside the recommendations, mostly for metformin (30% of the whole cohort) and for sitagliptin (17.9% of the whole cohort). With Cockcroft and Gault formula, 38.2% of persons were outside recommendations and 45.9% (p<0.001) with CKD-EPI de-indexed. Among individuals consulting a nephrologist for the first time (n=90), 61.1% were outside recommendations (p=0.1). Among those persons under diabetologist supervision (n=103), 63.1% were outside recommendations (p=0.09), and were taking significantly more often metformin and insulin.
  
  
  CONCLUSIONS
  We have found a substantial number of inadequate OAD prescriptions in type 2 diabetic patients with chronic kidney disease. The proportion of individuals outside guidelines was strongly affected by the method used for estimating GFR and by the type of practice, i.e., specialists versus general practitioners.
authors.affiliation: Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France; School of Medicine, University of Strasbourg, Rue Kirschleger, 67000, Strasbourg, France; UMR 1109, Laboratoire Immunologie et Rhumatologie, Strasbourg, France. Electronic address: clotilde-muller@hotmail.fr.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Muller
authors.affiliation: Haguenau Hospital, Nephrology department, 64 Avenue du Pr Leriche, 67500, Haguenau, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Dimitrov
authors.affiliation: Clinique Ste Anne, Nephrology department, Rue Philippe Thyss, 67085, Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Imhoff
authors.affiliation: Clinique Ste Anne, Nephrology department, Rue Philippe Thyss, 67085, Strasbourg, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Richter
authors.affiliation: Haguenau Hospital, Nephrology department, 64 Avenue du Pr Leriche, 67500, Haguenau, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Ott
authors.affiliation: Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Krummel
authors.affiliation: Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Bazin-Kara
authors.affiliation: Mulhouse Hospital, Nephrology department, 20 Avenue du Dr René Laennec, 68100, Mulhouse, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Chantrel
authors.affiliation: Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France; School of Medicine, University of Strasbourg, Rue Kirschleger, 67000, Strasbourg, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D000075202:Contraindications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D004704:Endocrinology; D005260:Female; D005602:France; D058005:General Practitioners; D005919:Glomerular Filtration Rate; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D057970:Inappropriate Prescribing; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D000078329:Workforce
chemical_list: D007004:Hypoglycemic Agents
keywords: Chronic kidney disease; Diabetes mellitus; Drug safety; Kidney function estimation; Oral anti-diabetic therapy