Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months
Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months
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DOI：
10.1186/1471-2369-14-249
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发表时间：
2013-11-12
期刊：
影响因子：
2.3
通讯作者：
Boulware, L. Ebony
中科院分区：
文献类型：
--
作者：
St Peter, Wendy L.;Sozio, Stephen M.;Boulware, L. Ebony
背景：几项观察性研究评估了血压 (BP) 药物单一暴露窗口对突发透析患者结局的影响，但血压药物处方模式是否保持稳定或单一暴露窗口设计是否足以评估对结局的影响尚不清楚。 方法：我们描述了血液透析和腹膜透析患者透析开始后 6 个月内的血压药物处方模式，按心血管合并症、糖尿病和其他患者特征进行分层。该队列包括 13,072 名成年患者（12,159 例血液透析，913 例腹膜透析），他们于 2003 年 1 月 1 日至 2008 年 6 月 30 日在 Dialysis Clinic, Inc. 设施中开始透析，并保持原来的模式至少 6 个月。我们评估了 6 个月内以及开始后 12 个月和 24 个月时血压药物处方的每月模式。结果：前 6 个月内，处方模式因透析方式而异；相当一部分在第 6 个月开出 β 受体阻滞剂、肾素血管紧张素系统药物和二氢吡啶类钙通道阻滞剂处方的患者到第 24 个月时不再开出这些药物的处方。特定药物类别的处方因合并症、种族/民族和年龄而异，但性别差异很小。血液透析和腹膜透析队列的第 6 个月平均用药次数为 2.5 次。结论：本研究评估了血液透析和腹膜透析患者在透析前 6 个月的血压用药模式。我们的研究结果强调了评估单一血压药物类别对透析患者的比较有效性的挑战。应使用纵向设计来解释血压药物管理随时间的变化，并应考虑纳入常见组合的设计。
Background: Several observational studies have evaluated the effect of a single exposure window with blood pressure (BP) medications on outcomes in incident dialysis patients, but whether BP medication prescription patterns remain stable or a single exposure window design is adequate to evaluate effect on outcomes is unclear.Methods: We described patterns of BP medication prescription over 6 months after dialysis initiation in hemodialysis and peritoneal dialysis patients, stratified by cardiovascular comorbidity, diabetes, and other patient characteristics. The cohort included 13,072 adult patients (12,159 hemodialysis, 913 peritoneal dialysis) who initiated dialysis in Dialysis Clinic, Inc., facilities January 1, 2003-June 30, 2008, and remained on the original modality for at least 6 months. We evaluated monthly patterns in BP medication prescription over 6 months and at 12 and 24 months after initiation.Results: Prescription patterns varied by dialysis modality over the first 6 months; substantial proportions of patients with prescriptions for beta-blockers, renin angiotensin system agents, and dihydropyridine calcium channel blockers in month 6 no longer had prescriptions for these medications by month 24. Prescription of specific medication classes varied by comorbidity, race/ethnicity, and age, but little by sex. The mean number of medications was 2.5 at month 6 in hemodialysis and peritoneal dialysis cohorts.Conclusions: This study evaluates BP medication patterns in both hemodialysis and peritoneal dialysis patients over the first 6 months of dialysis. Our findings highlight the challenges of assessing comparative effectiveness of a single BP medication class in dialysis patients. Longitudinal designs should be used to account for changes in BP medication management over time, and designs that incorporate common combinations should be considered.