Kuo Ko-Lin, Hung Szu-Chun, Liu Jia-Sin, Chang Yu-Kang, Hsu Chih-Cheng, Tarng Der-Cherng
Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Sci Rep. 2015 Nov 27;5:17150. doi: 10.1038/srep17150.
A combination therapy of pentoxifylline with an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) decreased proteinuria or glomerular filtration rate decline in early chronic kidney disease (CKD). Whether adding pentoxifylline to ACEI/ARB provides additional benefits on outcome is unclear in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND). A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From January 1, 2000 to June 30, 2009, we enrolled 14,117 CKD 5 ND with serum creatinine levels >6 mg/dL and hematocrit levels <28% and who have been treated with ACEI/ARB. All patients were divided into pentoxifylline users and nonusers. Patient follow-up took place until dialysis, death before initiation of dialysis or December 31, 2009. Finally, 9,867 patients (69.9%) required long-term dialysis and 2,805 (19.9%) died before dialysis. After propensity score-matching, use of pentoxifylline was associated with a lower risk for long-term dialysis or death in ACEI/ARB users (HR, 0.94; 95% CI, 0.90-0.99) or ARB users (HR, 0.91; 95% CI, 0.85-0.97). In conclusion, pentoxifylline exhibited a protective effect in reducing the risk for the composite outcome of long-term dialysis or death in ACEI/ARB treated CKD 5 ND.
己酮可可碱与血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）联合治疗可降低早期慢性肾脏病（CKD）患者的蛋白尿或减缓肾小球滤过率下降。对于尚未接受透析的CKD 5期患者（CKD 5 ND），在ACEI/ARB基础上加用己酮可可碱是否能带来更多获益尚不清楚。本研究基于台湾全民健康保险研究数据库进行了一项前瞻性队列研究。2000年1月1日至2009年6月30日期间，我们纳入了14117例CKD 5 ND患者，这些患者血清肌酐水平>6 mg/dL，血细胞比容水平<28%，且接受过ACEI/ARB治疗。所有患者分为己酮可可碱使用者和非使用者。对患者进行随访，直至其开始透析、在开始透析前死亡或至2009年12月31日。最终，9867例患者（69.9%）需要长期透析，2805例（19.9%）在透析前死亡。在进行倾向评分匹配后，己酮可可碱的使用与ACEI/ARB使用者长期透析或死亡风险较低相关（HR，0.94；95%CI，0.90 - 0.99），在ARB使用者中也是如此（HR，0.91；95%CI，0.85 - 0.97）。总之，己酮可可碱在降低接受ACEI/ARB治疗的CKD 5 ND患者长期透析或死亡复合结局风险方面具有保护作用。
