Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls.
Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls.
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DOI：
10.1093/ckj/sfab120
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发表时间：
2021-12
影响因子：
4.6
通讯作者：
Stel VS
中科院分区：
文献类型：
--
作者：
van Oosten MJM;Logtenberg SJJ;Hemmelder MH;Leegte MJH;Bilo HJG;Jager KJ;Stel VS
本研究旨在检查慢性肾病 (CKD) G4/G5 期患者和接受肾脏替代治疗 (KRT) 患者的多重用药 (PP) 患病率，并与普通人群的匹配对照进行比较。此外，我们还检查了 PP 的危险因素并描述了最常用的药物。荷兰健康声明数据用于确定三个患者组：CKD G4/G5 期、透析患者和肾移植患者。根据年龄、性别和社会经济地位（SES）评分，将每位患者与两名对照进行匹配。我们区分了“所有药物使用”和“慢性药物使用”。 PP 定义为三个级别：使用 ≥5 种药物 (PP)、≥10 种药物[过度 PP (EPP)] 和 ≥15 种药物[过度 PP (HPP)]。在 CKD G4/G5 期、透析患者和肾移植患者中，所有药物使用的 PP 患病率分别为 87%、93% 和 95%。对于长期药物使用，这一比例分别为 66%、70% 和 75%。患者的 PP 和合并症患病率高于对照组。 EPP 在年轻 CKD G4/G5 期患者（年龄 20-44 岁）中的发生率是对照组的 42 倍，而在 75 岁以上的患者中，这一比例为 3.8。年龄较大（64-75 岁和≥75 岁）是 CKD G4/G5 期和肾移植患者发生 PP 的危险因素。与年轻患者相比，≥75 岁的透析患者发生 PP 的风险较低。所有患者的其他危险因素包括社会经济地位低、糖尿病、血管疾病、住院和急诊室就诊。最常用的药物是质子泵抑制剂（PPI）和他汀类药物。 CKD G4/G5 期患者和接受 KRT 治疗的患者由于患有肾脏疾病和大量合并症，其药物负担很高，远远超出一般人群。一般药物处方以及 PPI 和他汀类药物（在透析人群中）等特定药物的关键方法可能是迈向更适当药物使用的第一步。
This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications. Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between ‘all medication use’ and ‘chronic medication use’. PP was defined at three levels: use of ≥5 medications (PP), ≥10 medications [excessive PP (EPP)] and ≥15 medications [hyper PP (HPP)]. The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20–44 years) than in controls, while this ratio was 3.8 in patients ≥75 years. Older age (64–75 and ≥75 years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients ≥75 years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins. CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.
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影响因子：
2.4
作者：
Adhikari UR;Taraphder A;Hazra A;Das T
通讯作者：
Das T
DOI：
10.3399/bjgp.2020.0871
发表时间：
2021-07
期刊：
The British journal of general practice : the journal of the Royal College of General Practitioners
影响因子：
--
作者：
MacRae C;Mercer S;Guthrie B
通讯作者：
Guthrie B
影响因子：
1.6
作者：
Mason, Nancy A.;Bakus, Jodie L.
通讯作者：
Bakus, Jodie L.
影响因子：
3.7
作者：
Mohnen, Sigrid M.;van Oosten, Manon J. M.;de Wit, G. Ardine
通讯作者：
de Wit, G. Ardine
影响因子：
6.1
作者：
Hayward, Samantha;Hole, Barnaby;Caskey, Fergus J.
通讯作者：
Caskey, Fergus J.