Sutaria Ankit, Liu Longjian, Ahmed Ziauddin
Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USACurrent affiliation: Child Health Epidemiologist, Maternal and Child Health Section, Georgia Department of Public Health, 2 Peachtree St, NW, 11-455, Atlanta, GA, USA.
Interim Chair, Department of Envirmental and Occupational Health, Associate Professor, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Room 515, Nesbitt Hall, 3215 Market Street, Philadelphia, PA 19104, USA
Ther Adv Cardiovasc Dis. 2016 Aug;10(4):242-50. doi: 10.1177/1753944716634579. Epub 2016 Feb 25.
Few studies have examined whether there was an independent association between multiple medication use and risk of chronic kidney disease (CKD), with adjustment for cardiometabolic factors. In the study, we aimed to examine this association using a nationally representative sample in CKD patients aged 60 and older.
In the study, subjects aged ⩾60 years (n = 1306) who participated in the 2011-2012 National Health and Nutrition Examination Survey were analyzed cross-sectionally. CKD was defined using the CKD Epidemiology Collaboration (CKD-EPI) equation i.e. estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2). Patients with multiple medications were classified as those having five or more prescription medications per day. All data analysis was performed using SAS 9.3 version.
The prevalence of CKD among age group ⩾80 years, age group 70-79 years and age group 60-69 years were 73.26%, 55.76% and 27.03% respectively (p < 0.001). About half of hypertension (HTN) and diabetic patients aged ⩾60 years had CKD. The prevalence of CKD in patients with cardiovascular disease (CVD) was 60.57%. The logistic regression model without adjustment reflects that those on multiple medications (⩾5 medications/day) had 1.53 (1.02-2.31) times as likely (53% increase) to have CKD compared with those on <5 medications/day. After adjustment for age, CVD, HTN and diabetes mellitus (DM), the odds of CKD for multiple medications appeared to have a protective effect, although it did not reach statistical significance. The adjusted odds ratio [95% confidence interval (CI)] was 0.89 (95% CI: 0.60-1.34); it showed an 11% decreased odds of CKD in patients who were taking multiple medications. The adjusted odds ratio for patients with CVD was 1.38 (95% CI: 0.97-1.98), HTN 1.13 (95% CI: 0.80-1.6), DM 1.78 (95% CI: 1.26-2.51) in age group 70-79 years 3.2 (95% CI: 2.1-4.87) and in age ⩾80 years 6.98 (95% CI: 4.02-12.11) compared with age group 60-69 years old, respectively.
We did not find significant independent association between use of multiple medications and CKD. The switchover of odds for multiple medication suggested a confounding effect of covariates; further prospective studies are required to find the individualized effect of multiple medications on CKD.
很少有研究在对心脏代谢因素进行校正后，探讨多种药物联合使用与慢性肾脏病（CKD）风险之间是否存在独立关联。在本研究中，我们旨在使用全国代表性样本，对60岁及以上的CKD患者进行该关联研究。
在本研究中，对参加2011 - 2012年全国健康与营养检查调查的年龄≥60岁（n = 1306）的受试者进行横断面分析。CKD采用CKD流行病学协作组（CKD-EPI）公式定义，即估算肾小球滤过率（eGFR）<60 ml/min/1.73 m²。服用多种药物的患者被定义为每天服用五种或更多处方药的患者。所有数据分析均使用SAS 9.3版本进行。
80岁及以上年龄组、70 - 79岁年龄组和60 - 69岁年龄组的CKD患病率分别为73.26%、55.76%和27.03%（p < 0.001）。60岁及以上的高血压（HTN）和糖尿病患者中约一半患有CKD。心血管疾病（CVD）患者的CKD患病率为60.57%。未校正的逻辑回归模型显示，服用多种药物（≥5种药物/天）的患者患CKD的可能性是每天服用<5种药物患者的1.53（1.02 - 2.31）倍（增加53%）。在对年龄、CVD、HTN和糖尿病（DM）进行校正后，多种药物使用与CKD的比值比似乎具有保护作用，尽管未达到统计学意义。校正后的比值比[95%置信区间（CI）]为0.89（95% CI：0.60 - 1.34）；表明服用多种药物的患者患CKD的几率降低了11%。70 - 79岁年龄组中，CVD患者校正后的比值比为1.38（95% CI：0.97 - 1.98），HTN患者为1.13（95% CI：0.80 - 1.6），DM患者为1.78（95% CI：1.26 - 2.51）；≥80岁年龄组与60 - 69岁年龄组相比，分别为3.2（95% CI：2.1 - 4.87）和6.98（95% CI：4.02 - 12.11）。
我们未发现多种药物联合使用与CKD之间存在显著的独立关联。多种药物使用比值比的转变提示协变量存在混杂效应；需要进一步开展前瞻性研究以明确多种药物对CKD的个体化影响。
