Bailie George R, Eisele George, Liu Lei, Roys Erik, Kiser Margaret, Finkelstein Frederick, Wolfe Robert, Port Friedrich, Burrows-Hudson Sally, Saran Rajiv
Albany Nephrology Pharmacy Group, Albany College of Pharmacy, 106 New Scotland Avenue, Albany, NY 12208, USA.
Nephrol Dial Transplant. 2005 Jun;20(6):1110-5. doi: 10.1093/ndt/gfh771. Epub 2005 Mar 15.
Patients with chronic kidney disease (CKD) stages 2-5 are known to suffer numerous complications and co-morbidities associated with kidney disease. The medication prescription patterns in this population are not well understood. We report on prescription data collected as part of a multicentre longitudinal study in patients with CKD, with a focus on medications with cardiovascular or cardioprotective effects.
Patients were recruited from four academic nephrology centres in the USA, with patient recruitment from June 2000 to March 2002. Medication data were captured at the time of first enrollment into the study. Individual medications were classified into medication groups, and those with predominant cardioprotective effects or for prevention of progression of kidney disease (e.g. medications for treatment of anaemia, lipid-lowering agents, antihypertensives, statins, etc.) were recorded for analysis. Descriptive statistics were used for medication prescription according to baseline demographics and co-morbidities. Predictors of epoetin and iron use were determined by logistic regression adjusting for age, race, sex, diabetes, glomerular filtration rate (GFR), haemoglobin and serum albumin.
Medication data were available for 619 patients with stages 2-5 CKD. Patients were 60.6+/-16.0 years of age, and were prescribed 8+/-4 (range 1-28) medications. Overall, the proportion of patients prescribed different classes of medications included epoetin (20%), intravenous iron (13%), HMG-CoA reductase inhibitors (16%), angiotensin-converting enzyme (ACE) inhibitors (44%), angiotensin receptor blockers (13%), beta-blockers (46%), calcium channel blockers (52%) and aspirin (37%). There was a low use of epoetin (45%) and iron (20%) in patients with anaemia. Only 24% of patients with coronary artery disease were prescribed statins, and ACE inhibitors and angiotensin receptor blockers were used in only 58 and 23% of diabetic patients with proteinuria. Positive predictors of epoetin and iron therapy included white race and diabetes. Higher GFR and higher serum albumin were associated with lower odds of being prescribed epoetin. White race and diabetics were more likely to be prescribed iron.
This study provides an overview of prescription practices in a cohort of CKD patients. Substantial underutilization of certain classes of cardioprotective medications is apparent, and systematic educational efforts in this direction may well prove worthwhile to impact outcomes.
已知慢性肾脏病（CKD）2 - 5期患者会出现许多与肾脏疾病相关的并发症和合并症。该人群的用药处方模式尚未得到充分了解。我们报告了作为CKD患者多中心纵向研究一部分收集的处方数据，重点关注具有心血管或心脏保护作用的药物。
患者从美国四个学术肾脏病中心招募，招募时间为2000年6月至2002年3月。在首次纳入研究时收集用药数据。将个体药物分类为药物组，并记录那些具有主要心脏保护作用或用于预防肾脏疾病进展的药物（例如治疗贫血的药物、降脂药、抗高血压药、他汀类药物等）进行分析。根据基线人口统计学和合并症对用药处方进行描述性统计。通过对年龄、种族、性别、糖尿病、肾小球滤过率（GFR）、血红蛋白和血清白蛋白进行调整的逻辑回归确定促红细胞生成素和铁使用的预测因素。
有619例CKD 2 - 5期患者的用药数据可用。患者年龄为60.6±16.0岁，每人处方8±4种（范围1 - 28种）药物。总体而言，开具不同类别药物的患者比例包括促红细胞生成素（20%）、静脉铁剂（13%）、HMG - CoA还原酶抑制剂（16%）、血管紧张素转换酶（ACE）抑制剂（44%）、血管紧张素受体阻滞剂（13%）、β受体阻滞剂（46%）、钙通道阻滞剂（52%）和阿司匹林（37%）。贫血患者中促红细胞生成素（45%）和铁剂（20%）的使用比例较低。仅24%的冠心病患者开具了他汀类药物，蛋白尿糖尿病患者中分别只有58%和23%使用了ACE抑制剂和血管紧张素受体阻滞剂。促红细胞生成素和铁剂治疗的阳性预测因素包括白种人和糖尿病。较高的GFR和较高的血清白蛋白与开具促红细胞生成素的较低几率相关。白种人和糖尿病患者更有可能开具铁剂。
本研究概述了一组CKD患者的处方实践。某些类别的心脏保护药物明显未得到充分利用，在这方面进行系统的教育努力可能很值得，以影响治疗结果。
