Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Drugs Aging. 2021 Dec;38(12):1097-1105. doi: 10.1007/s40266-021-00903-0. Epub 2021 Dec 3.
Reduced estimated creatinine clearance (eCrCl) is prevalent in older patients and impacts on drug prescription. In this study, the burden of eCrCl reduction and its associated factors and impact on outcomes were analyzed. Moreover, the rate of inappropriate drug prescription according to eCrCl and its impact on outcomes were described.
Data were obtained from "REgistro POliterapie SIMI" (REPOSI), a prospective observational register enrolling hospitalized patients aged ≥ 65 years. Patients enrolled from 2010-2016 with available data to calculate eCrCl according to the Cockcroft-Gault formula were included in this analysis.
A total of 5046 patients were available for analysis. Among these, we found an eCrCl of 45-59 mL/min in 1163 patients (23.0%), an eCrCl of 30-44 mL/min in 1128 (22.4%), an eCrCl of 15-29 mL/min in 702 (13.9%), and an eCrCl < 15 mL/min in 152 (3.0%), with several clinical factors associated with decreasing eCrCl. During follow-up, a progressively higher risk for all-cause death, cardiovascular (CV) death, any death/re-hospitalization, and CV death/re-hospitalization was found across the renal function classes. Among patients with hypertension, diabetes mellitus, atrial fibrillation, coronary artery disease, and heart failure, 476 (10.9%) were inappropriately prescribed medications according to eCrCl. During follow-up, inappropriate prescription was associated with increased risk of all-cause death (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.13-1.97) and any death/re-hospitalization (OR 1.30, 95% CI 1.03-1.63).
In older hospitalized patients, impaired eCrCl is prevalent and associated with several factors, polypharmacy in particular. Patients with reduced eCrCl have a higher risk of major clinical outcomes, and > 10% of them are prescribed an inappropriate drug, with a higher risk for major clinical outcomes.
估算的肾小球滤过率（eCrCl）降低在老年患者中较为常见，并会影响药物的处方。本研究分析了 eCrCl 降低的负担及其相关因素和对结局的影响。此外，还描述了根据 eCrCl 开具不适当药物的比率及其对结局的影响。
数据来自“REgistro POliterapie SIMI”（REPOSI），这是一个前瞻性观察性登记，纳入年龄≥65 岁的住院患者。本分析纳入了 2010-2016 年期间入组且根据 Cockcroft-Gault 公式可获得 eCrCl 数据的患者。
共纳入 5046 例患者。其中，1163 例（23.0%）患者的 eCrCl 为 45-59ml/min，1128 例（22.4%）患者的 eCrCl 为 30-44ml/min，702 例（13.9%）患者的 eCrCl 为 15-29ml/min，152 例（3.0%）患者的 eCrCl<15ml/min。有多种临床因素与 eCrCl 降低相关。在随访期间，肾功能各等级患者的全因死亡、心血管（CV）死亡、任何死亡/再住院和 CV 死亡/再住院风险逐渐升高。在患有高血压、糖尿病、心房颤动、冠心病和心力衰竭的患者中，根据 eCrCl 计算，476 例（10.9%）患者的药物处方不恰当。在随访期间，不恰当的处方与全因死亡风险增加（比值比[OR]1.49，95%置信区间[CI]1.13-1.97）和任何死亡/再住院风险增加（OR 1.30，95%CI 1.03-1.63）相关。
在老年住院患者中，eCrCl 受损较为常见，与多种因素有关，尤其是与多种药物相关。eCrCl 降低的患者发生主要临床结局的风险较高，>10%的患者开具了不适当的药物，发生主要临床结局的风险更高。
