van Blijderveen Jan C, Straus Sabine M, de Ridder Maria A, Stricker Bruno H, Sturkenboom Miriam C, Verhamme Katia M
Department of Medical Informatics, Erasmus Medical Center, Room Ee2116, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands,
Drug Saf. 2014 May;37(5):369-77. doi: 10.1007/s40264-014-0160-0.
Acute kidney injury (AKI) might complicate antihypertensive therapy. In The Netherlands, general practitioner clinical practice guidelines provide clear recommendations on monitoring of renal function to minimize this risk. Our objective was to investigate how day-to-day clinical practice corresponds to the guidelines.
We conducted a retrospective cohort study in a dynamic population, using data on >9,000 adults that was retrieved from the Integrated Primary Care Information database. We investigated whether serum creatinine (SCR) was measured within 30 and 365 days after the start of (combined) use of a diuretic, an angiotensin-converting enzyme inhibitor, and/or angiotensin receptor blocker. We also investigated the association between calendar year, sex, type of therapy, risk factors for AKI and practice and SCR measurement.
Of 6,593 subjects who met the study criteria for single drug therapy, SCR was measured in 1,233 subjects within 30 days and in 3,896 subjects within 365 days. For combined drug therapy recipients (n = 2,497), these were 545 and 1,687, respectively. Associated cumulative probabilities were 19 % and 66 % with single drug therapy, and 22 % and 74 % with combined drug therapy. Significant differences were observed between practices. SCR measurement was associated with other characteristics, except for sex. Within 365 days, SCR increased >30 % of baseline in 103 subjects (1.6 %) after the start of single drug therapy, and in 85 (3.4 %) subjects who initiated combined drug therapy. In the majority (>70 %) of these subjects, this did not result in subsequent monitoring or adjustment of antihypertensive treatment.
Results from this study suggest that, on average, renal function is not monitored as strictly as recommended by relevant clinical practice guidelines.
急性肾损伤（AKI）可能会使抗高血压治疗复杂化。在荷兰，全科医生临床实践指南对肾功能监测给出了明确建议，以将这种风险降至最低。我们的目的是调查日常临床实践与这些指南的符合程度。
我们在一个动态人群中进行了一项回顾性队列研究，使用从综合初级保健信息数据库中检索到的9000多名成年人的数据。我们调查了在开始联合使用利尿剂、血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂后的30天和365天内是否测量了血清肌酐（SCR）。我们还调查了日历年、性别、治疗类型、AKI危险因素及医疗实践与SCR测量之间的关联。
在符合单药治疗研究标准的6593名受试者中，1233名受试者在30天内测量了SCR，3896名受试者在365天内测量了SCR。对于联合药物治疗的接受者（n = 2497），这两个数字分别为545和1687。单药治疗的相关累积概率分别为19%和66%，联合药物治疗的相关累积概率分别为22%和74%。不同医疗实践之间观察到显著差异。SCR测量与除性别外的其他特征相关。在365天内,单药治疗开始后，103名受试者（1.6%）的SCR升高超过基线的30%，开始联合药物治疗的85名受试者（3.4%）的SCR升高超过基线的30%。在这些受试者中的大多数（>70%）中，这并未导致随后对抗高血压治疗的监测或调整。
本研究结果表明，平均而言，肾功能监测并未像相关临床实践指南所建议的那样严格。
