[Cardiovascular drugs and renal function: Pitfall of renal adaptation]

Introduction: Chronic kidney disease is associated with a high likelihood of receiving cardiovascular drugs. The Haute Autoritéde santé in France still recommends the use of the Cockcroft and Gault formula for dosage adjustments, on the pretext that it is the main data available in the Vidal^® drug database. To verify this assumption, we conducted a systematic review of the Vidal^® database by looking for the method recommended for evaluating renal function for the purpose of dose adjustment of cardiovascular drugs.

Methods: Vidal^® files and SPC of Cardiovascular Drug (ATC classifications B01 and C) were analyzed and classified according to the method of evaluation or measurement of renal function recommended for dose adjustments.

Results: A total of 196 molecules were identified, of which 62.6% required dose adjustment to renal function. The most commonly used evaluation method was creatinine clearance (without precision about estimation or measurement) with a frequency of 35.5%. The frequency of use of the Cockcroft and Gault formula was 3.9% (8.4% after review of the literature concerning the molecules stating the clearance of creatinine, as the reference method).

Conclusion: The privileged use of Cockcroft and Gault formula for dose adjustment, as recommended by the Haute Autoritéde santé, does not seem to be justified. An overhaul of recommendations for pharmacokinetic studies and renal function assessment methods for dose adjustments appears necessary.