Pharmacoepidemiology for nephrologists: do proton pump inhibitors cause chronic kidney disease?
Pharmacoepidemiology for nephrologists: do proton pump inhibitors cause chronic kidney disease?
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DOI：
10.1093/ndt/gfw349
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发表时间：
2017-04-01
期刊：
影响因子：
--
通讯作者：
Nitsch D
中科院分区：
文献类型：
--
作者：
Tomlinson LA;Fogarty DG;Douglas I;Nitsch D
药物流行病学研究越来越多地用于研究慢性肾脏病（CKD）的安全处方。通常情况下，处方药物的患者与未服用药物的患者进行比较，并比较结果以得出有关药物效果的结论。这篇评论文章旨在为读者提供一个框架，以批判性地评价这种研究。药物流行病学研究中的一个关键问题是混淆，因为健康状况较差的患者被处方更多的药物或不同的药物，其不良结局归因于药物而不是健康状况。使用统计方法对此进行调整可能具有挑战性，除非确定了具有相似健康状况但处方不同（比较）药物的比较组。药物流行病学的另一个挑战是结果错误分类，因为病情更严重的人更经常参与卫生服务，导致经常参加的人更早诊断。最后，在同一类型的卫生系统中使用相同方法的复制队列并不能确保结果更加可靠。我们使用最近的两篇论文，研究质子泵抑制剂药物与CKD的关联作为一种设备，以审查药物流行病学研究的主要陷阱，以及如何尝试减轻可能发生的潜在偏倚。
Pharmacoepidemiology studies are increasingly used for research into safe prescribing in chronic kidney disease (CKD). Typically, patients prescribed a drug are compared with patients who are not on the drug and outcomes are compared to draw conclusions about the drug effects. This review article aims to provide the reader with a framework to critically appraise such research. A key concern in pharmacoepidemiology studies is confounding, in that patients who have worse health status are prescribed more drugs or different agents and their worse outcomes are attributed to the drugs not the health status. It may be challenging to adjust for this using statistical methods unless a comparison group with a similar health status but who are prescribed a different (comparison) drug(s) is identified. Another challenge in pharmacoepidemiology is outcome misclassification, as people who are more ill engage more often with the health service, leading to earlier diagnosis in people who are frequent attenders. Finally, using replication cohorts with the same methodology in the same type of health system does not ensure that findings are more robust. We use two recent papers that investigated the association of proton pump inhibitor drugs with CKD as a device to review the main pitfalls of pharmacoepidemiology studies and how to attempt to mitigate against potential biases that can occur.
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影响因子：
39.2
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1136/bmj.e4388
发表时间：
2012-07-10
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
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通讯作者：
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影响因子：
29
作者：
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通讯作者：
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作者：
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