Use of Newer Anticoagulants in Patients With Chronic Kidney Disease

Bob L. Lobo

Disclosures

Am J Health Syst Pharm. 2007;64(19):2017-2026. 

In This Article

Renal Impairment Among Hospitalized Patients

As in the general population, hospitalized patients with impaired renal function most often have impairment that is mild to moderate in severity.[10,11,12] In a recent study involving 352 medical inpatients at a tertiary care hospital, 36% of patients had mild renal impairment (stage 2 CKD), 15% had moderate renal impairment (stage 3 CKD), and only 9% of patients had severe renal impairment (stage 4 or 5 CKD, GFR of <30 mL/min).[12] In a larger study of 3800 hospitalized patients at a teaching hospital in the United States, only 5% of patients had a GFR of <40 mL/min.[10] Likewise, only 1 (8%) of 12 patients treated for ACS at another tertiary care teaching hospital were reported to have significant renal impairment when defined as an SCr concentration of >150 µmol/L (1.7 mg/dL).[11]

Renal impairment is especially prevalent among elderly hospitalized patients.[13] According to a recent analysis of data from the Gruppo Italiano di Farmacovilanza nell&'Anziano study, 13.9% of all elderly hospitalized patients had a decreased GFR despite normal SCr levels.[13] Clinicians should be especially alert to the potential for postoperative changes in renal function in elderly patients.[14] In a study of 84 elderly patients (age >70 years) who underwent total joint replacement, 8.5% of patients with normal preoperative renal function were found to have abnormal postoperative creatinine clearance (CLcr) values, while 14.2% of patients with abnormal preoperative renal function were found to have a further worsening in their postoperative CLcr.[14]

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