Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis
Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis
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DOI：
10.1053/j.ajkd.2016.02.051
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发表时间：
2016-10-01
影响因子：
13.2
通讯作者：
Kovesdy, Csaba P.
中科院分区：
文献类型：
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作者：
Molnar, Miklos Z.;Gosmanova, Elvira O.;Kovesdy, Csaba P.
背景：在普通人群中，不坚持用药是一个已知的不良后果的危险因素。研究设计：观察性研究。背景与参与者：在2007至2011年间，32,348名美国退伍军人过渡到透析。预测因素：坚持心血管药物治疗，使用覆盖天数比例(PDC)和透析前一年的持久性从药房数据库记录中确定。结果：透析后治疗开始，使用COX模型并调整混杂因素。结果：队列的平均年龄为72 6 11岁(SD)；96%是男性，74%是白人，23%是非裔美国人，69%患有糖尿病。在平均23个月(IQR，9-36个月)的随访中，18,608名患者死亡。在PDC患者中。80%，有14,006例死亡(死亡率，283[95%可信区间，278-288]/1000病人年])；在PDC患者中。60%至80%，有3882人死亡(死亡率，294[95%可信区间，285-304]/1000病人年)；在PDC患者中
Background: Medication nonadherence is a known risk factor for adverse outcomes in the general population. However, little is known about the association of predialysis medication adherence among patients with advanced chronic kidney disease and mortality following their transition to dialysis.Study Design: Observational study.Setting & Participants: 32,348 US veterans who transitioned to dialysis during 2007 to 2011.Predictors: Adherence to treatment with cardiovascular drugs, ascertained from pharmacy database records using proportion of days covered (PDC) and persistence during the predialysis year.Outcomes: Post-dialysis therapy initiation all-cause and cardiovascular mortality, using Cox models with adjustment for confounders.Results: Mean age of the cohort was 72 6 11 (SD) years; 96% were men, 74% were white, 23% were African American, and 69% had diabetes. During a median follow-up of 23 (IQR, 9-36) months, 18,608 patients died. Among patients with PDC. 80%, there were 14,006 deaths (mortality rate, 283 [95% CI, 278-288]/1,000 patient-years]); among patients with PDC. 60% to 80%, there were 3,882 deaths (mortality rate, 294 [95% CI, 285-304]/1,000 patient-years); among patients with PDC