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Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort
BACKGROUND: Direct oral anticoagulants (DOACs) pharmacokinetics depends on estimated glomerular filtration rate (eGFR), whose estimation is crucial for optimal risk/benefit balance. AIMS: To assess the concordance among different eGFR formulas and the potential impact on DOACs prescription appropria...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894223/ https://www.ncbi.nlm.nih.gov/pubmed/34661901 http://dx.doi.org/10.1007/s40520-021-01986-w |
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author | Calsolaro, Valeria Okoye, Chukwuma Rogani, Sara Calabrese, Alessia Maria Dell’Agnello, Umberto Antognoli, Rachele Guarino, Daniela Monzani, Fabio |
author_facet | Calsolaro, Valeria Okoye, Chukwuma Rogani, Sara Calabrese, Alessia Maria Dell’Agnello, Umberto Antognoli, Rachele Guarino, Daniela Monzani, Fabio |
author_sort | Calsolaro, Valeria |
collection | PubMed |
description | BACKGROUND: Direct oral anticoagulants (DOACs) pharmacokinetics depends on estimated glomerular filtration rate (eGFR), whose estimation is crucial for optimal risk/benefit balance. AIMS: To assess the concordance among different eGFR formulas and the potential impact on DOACs prescription appropriateness and bleeding risk in oldest hospitalized patients. METHODS: Post hoc analysis of a single-centre prospective cohort study. eGFR was calculated by creatinine-based (MDRD, CKD-EPI(Cr), BIS(1)) and creatinine–cystatin-C-based (CKD-EPI(Comb) and BIS(2)) formulas. Patients were stratified according to eGFR [severely depressed (SD) 15–29; moderately depressed (MD) 30–49; preserved/mildly depressed (PMD): ≥ 50 ml/min/1.73 m(2)]. Concordance between the different equations was assessed by Cohen’s kappa coefficient. RESULTS: Among AF patients, 841 (59.2% women, mean age 85.9 ± 6.5 years) received DOACs. By CKD-EPI(Cr) equation, 135 patients were allocated in the SD, 255 in the MD and 451 in the PMD group. The concordance was excellent only between BIS 2 and CKD-EPI(Comb) and MDRD and CKD-EPI(Cr), while was worse (from good to poor) between the other formulas. Indeed, by adding cystatin-C almost over 1/3 of the patients were reallocated to a worse eGFR class. Bleeding prevalence increased by 2–3% in patients with discordant eGFR between formulas, reallocated to a worse chronic kidney disease (CKD) stage, although without reaching statistical significance. CKD-EPI(Comb) resulted the best predictor of bleeding events (AUROC 0.71, p = 0.03). DISCUSSION: This study highlights the variability in CKD staging according to different eGFR formulas, potentially determining inappropriate DOACs dosing. Although the cystatin-C derived CKDEPI(Comb) equation is the most accurate for stratifying patients, BIS(1) may represent a reliable alternative. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-021-01986-w. |
format | Online Article Text |
id | pubmed-8894223 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-88942232022-03-08 Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort Calsolaro, Valeria Okoye, Chukwuma Rogani, Sara Calabrese, Alessia Maria Dell’Agnello, Umberto Antognoli, Rachele Guarino, Daniela Monzani, Fabio Aging Clin Exp Res Original Article BACKGROUND: Direct oral anticoagulants (DOACs) pharmacokinetics depends on estimated glomerular filtration rate (eGFR), whose estimation is crucial for optimal risk/benefit balance. AIMS: To assess the concordance among different eGFR formulas and the potential impact on DOACs prescription appropriateness and bleeding risk in oldest hospitalized patients. METHODS: Post hoc analysis of a single-centre prospective cohort study. eGFR was calculated by creatinine-based (MDRD, CKD-EPI(Cr), BIS(1)) and creatinine–cystatin-C-based (CKD-EPI(Comb) and BIS(2)) formulas. Patients were stratified according to eGFR [severely depressed (SD) 15–29; moderately depressed (MD) 30–49; preserved/mildly depressed (PMD): ≥ 50 ml/min/1.73 m(2)]. Concordance between the different equations was assessed by Cohen’s kappa coefficient. RESULTS: Among AF patients, 841 (59.2% women, mean age 85.9 ± 6.5 years) received DOACs. By CKD-EPI(Cr) equation, 135 patients were allocated in the SD, 255 in the MD and 451 in the PMD group. The concordance was excellent only between BIS 2 and CKD-EPI(Comb) and MDRD and CKD-EPI(Cr), while was worse (from good to poor) between the other formulas. Indeed, by adding cystatin-C almost over 1/3 of the patients were reallocated to a worse eGFR class. Bleeding prevalence increased by 2–3% in patients with discordant eGFR between formulas, reallocated to a worse chronic kidney disease (CKD) stage, although without reaching statistical significance. CKD-EPI(Comb) resulted the best predictor of bleeding events (AUROC 0.71, p = 0.03). DISCUSSION: This study highlights the variability in CKD staging according to different eGFR formulas, potentially determining inappropriate DOACs dosing. Although the cystatin-C derived CKDEPI(Comb) equation is the most accurate for stratifying patients, BIS(1) may represent a reliable alternative. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-021-01986-w. Springer International Publishing 2021-10-18 2022 /pmc/articles/PMC8894223/ /pubmed/34661901 http://dx.doi.org/10.1007/s40520-021-01986-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Calsolaro, Valeria Okoye, Chukwuma Rogani, Sara Calabrese, Alessia Maria Dell’Agnello, Umberto Antognoli, Rachele Guarino, Daniela Monzani, Fabio Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort |
title | Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort |
title_full | Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort |
title_fullStr | Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort |
title_full_unstemmed | Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort |
title_short | Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort |
title_sort | different glomerular filtration rate estimating formula for prescribing doacs in oldest patients: appropriate dosage and bleeding risk. post hoc analysis of a prospective cohort |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894223/ https://www.ncbi.nlm.nih.gov/pubmed/34661901 http://dx.doi.org/10.1007/s40520-021-01986-w |
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