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. 2019 Jun 10;13(2):199-207.
doi: 10.1093/ckj/sfz063. eCollection 2020 Apr.

Impact of age on cardiovascular drug use in patients with chronic kidney disease

Cédric Villain  1   2 , Sophie Liabeuf  2   3 , Marie Metzger  2 , Christian Combe  4   5 , Denis Fouque  6 , Luc Frimat  7   8 , Christian Jacquelinet  2   9 , Maurice Laville  6 , Serge Briançon  8 , Ronald L Pisoni  10 , Nicolas Mansencal  2   11 , Bénédicte Stengel  2 , Ziad A Massy  1   2
Affiliations

Impact of age on cardiovascular drug use in patients with chronic kidney disease

Cédric Villain et al. Clin Kidney J. .

Abstract

Background: Elderly patients with chronic kidney disease (CKD) are often excluded from clinical trials; this may affect their use of essential drugs for cardiovascular complications. We sought to assess the impact of age on cardiovascular drug use in elderly patients with CKD.

Methods: We used baseline data from the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort including 3033 adult patients with CKD Stages 3 and 4. We studied the use of recommended drugs for coronary artery disease (CAD), stroke and atrial fibrillation by age, after adjusting for socio-demographic and clinical conditions.

Results: The patients' mean age was 66.8 years (mean estimated glomerular filtration rate 32.9 mL/min/1.73 m2). The prevalence of CAD was 24.5% [81.3% receiving antiplatelet agents, 75.6% renin-angiotensin system (RAS) blockers, 65.4% β-blockers and 81.3% lipid-lowering therapy], that of stroke 10.0% (88.8% receiving antithrombotic drugs) and that of atrial fibrillation 11.1% (69.5% receiving oral anticoagulants). Compared with patients aged <65 years, older age (≥65 years) was associated with greater use of antithrombotic drugs in stroke [adjusted odds ratio (aOR) (95% confidence interval) = 2.83 (1.04-7.73) for patients aged (75-84 years)] and less use of RAS blockers [aOR = 0.39 (0.16-0.89) for patients aged ≥85 years], β-blockers [aOR = 0.31 (0.19-0.53) for patients aged 75-84 years] and lipid-lowering therapy [aOR = 0.39 (0.15-1.02) for patients aged ≥85 years, P for trend = 0.01] in CAD. Older age was not associated with less use of antiplatelet agents in CAD or oral anticoagulants in atrial fibrillation.

Conclusions: In patients with CKD, older age per se was not associated with the underuse of antithrombotic drugs but was for other major drugs, with a potential impact on cardiovascular outcomes.

Keywords: atrial fibrillation; chronic kidney disease; coronary artery disease; elderly; stroke; underuse.

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Figures

FIGURE 1
FIGURE 1
Percentage of CVD drug use by age class in patients with CKD. RAS: reninangiotensin system; the antithrombotic drugs included antiplatelet agents and oral anticoagulants.
FIGURE 2
FIGURE 2
Percentages of patients according to the number of recommended drugs used to treat CAD: comparison by age class and estimated glomerular filtration rate (eGFR) class. The appropriate drugs for CAD included antithrombotic drugs (antiplatelet agents or oral anticoagulants), renin–angiotensin blockers, β-blockers, and statins or ezetimibe.
See this image and copyright information in PMC

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