Comparison of Class-Specific Side Effects Across Preventative Pharmacologic Therapies for Kidney Stone Disease.
Comparison of Class-Specific Side Effects Across Preventative Pharmacologic Therapies for Kidney Stone Disease.
复制标题
肾结石疾病预防性药物治疗的特定类别副作用的比较。
DOI：
10.1097/upj.0000000000000470
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发表时间：
2024
期刊：
影响因子：
0.8
通讯作者：
Hollingsworth,JohnM
中科院分区：
文献类型：
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作者：
Hsi,RyanS;Crivelli,JosephJ;Yan,PhyllisL;Shahinian,Vahakn;Hollingsworth,JohnM
临床指南建议在肾结石的预防性药物治疗中监测代谢紊乱。本研究的目的是比较接受碱性柠檬酸、噻嗪和别嘌醇治疗的患者的副作用发生率。方法利用2008-2019年工作年龄成人肾结石患者的索赔数据，我们确定了那些在与结石相关的指征诊断或手术后12个月内使用新处方的患者。我们建立了多变量Logistic回归模型，调整了并存疾病和服药依从性等队列特征，估计了急性肾损伤、跌倒/髋部骨折、胃炎、肝功能异常/肝炎、高钙血症、高血糖/糖尿病、高钾血症、低钾血症、低钠血症和低血压患者2年内基于索赔结果的测量频率。结果我们的队列患者中分别有1776人(34%)、2767人(53%)和677人(13%)服用了碱性柠檬酸盐、噻嗪或别嘌醇。比较未调整的诊断率，与柠檬酸盐碱和别嘌醇相比，噻嗪类药物与最高的高钙血症(2.3%比1.5%和1.0%，P=0.04)、低钾血症(6%比3%和2%，P<；.01)和高血糖/糖尿病(17%比11%和16%，P<；.01)相关。其他结果与其他结果均无显著差异。在校正分析中，与柠檬酸盐碱相比，噻嗪类药物与低血钾(OR=2.01，95%CI 1.44~2.81)和高血糖/糖尿病(OR=1.52，95%CI 1.26~1.83)相关，而别嘌醇与高血糖/糖尿病相关(OR=1.34，95%CI 1.02~1.75)。结论这些数据支持推荐定期血清检测以评估预防性药物治疗不良反应的临床指南。
IntroductionClinical guidelines recommend monitoring for metabolic derangements while on preventive pharmacologic therapy for kidney stone disease. The study objective was to compare the frequency of side effects among patients receiving alkali citrate, thiazides, and allopurinol.MethodsUsing claims data from working-age adults with kidney stone disease (2008-2019), we identified those with a new prescription for alkali citrate, thiazide, or allopurinol within 12 months after their index stone-related diagnosis or procedure. We fit multivariable logistic regression models, adjusting for cohort characteristics like comorbid illness and medication adherence, to estimate 2-year measured frequencies of claims-based outcomes of acute kidney injury, falls/hip fracture, gastritis, abnormal liver function tests/hepatitis, hypercalcemia, hyperglycemia/diabetes, hyperkalemia, hypokalemia, hyponatremia, and hypotension.ResultsOur cohort consisted of 1776 (34%), 2767 (53%), and 677 (13%) patients prescribed alkali citrate, thiazides, or allopurinol, respectively. Comparing unadjusted rates of incident diagnoses, thiazides compared to alkali citrate and allopurinol were associated with the highest rates of hypercalcemia (2.3% vs 1.5% and 1.0%, respectively,P= .04), hypokalemia (6% vs 3% and 2%, respectively,P< .01), and hyperglycemia/diabetes (17% vs 11% and 16%, respectively,P< .01). No other differences with the other outcomes were significant. In adjusted analyses, compared to alkali citrate, thiazides were associated with a higher odds of hypokalemia (OR=2.01, 95% CI 1.44-2.81) and hyperglycemia/diabetes (OR=1.52, 95% CI 1.26-1.83), while allopurinol was associated with a higher odds of hyperglycemia/diabetes (OR=1.34, 95% CI 1.02-1.75).ConclusionsThese data provide evidence to support clinical guidelines that recommend periodic serum testing to assess for adverse effects from preventive pharmacologic therapy.