Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taiwan.
Eur J Intern Med. 2017 Oct;44:67-73. doi: 10.1016/j.ejim.2017.06.011. Epub 2017 Jun 17.
We aimed to evaluate the potential benefits of N-acetylcysteine (NAC) on the risk of chronic kidney disease (CKD) progression to dialysis-requiring end-stage renal disease (ESRDd).
In a population-based cohort study of 145,062 individuals, 123,608 CKD patients who were followed up for 10years were included, and CKD patients treated with NAC (ICD-9-CM) were compared with those who were not treated. Using propensity score matching, we analyzed the predictors of CKD progression to ESRDd by Cox proportional hazards regression with adjustments for sex, age, and comorbidities, and evaluated the effect of NAC using cumulative defined daily dose (cDDD).
NAC use was associated with a reduced risk for progression to ESRDd [hazard ratio (HR), 0.819; 95% confidence interval (CI), 0.781-0.965; P=0.017]. Risk reduction was proportional to cDDD in NAC users compared with that in NAC non users (HR, 0.835, 0.811, and 0.799 for cDDD 91-180, 181-360, and >360, respectively; P for trend=0.018). Risk reduction was apparent in women (P=0.001) and in younger-aged patients of 18-29years (P=0.021) and 30-39years (P=0.033), in the presence of hypertension (P=0.003), and in the absence of diabetes mellitus (P=0.042) and congestive heart failure (P=0.036).
NAC use was associated with a reduced risk for progression to ESRDd. These results, obtained from retrospective data, indicate that a prospective study is warranted.
我们旨在评估 N-乙酰半胱氨酸（NAC）对慢性肾脏病（CKD）进展为需要透析的终末期肾脏疾病（ESRDd）的风险的潜在益处。
在一项基于人群的队列研究中，纳入了 145062 名个体，其中包括 123608 名随访 10 年的 CKD 患者，比较了接受 NAC（ICD-9-CM）治疗和未接受治疗的 CKD 患者。使用倾向评分匹配，我们通过 Cox 比例风险回归分析调整性别、年龄和合并症后，分析了 CKD 进展为 ESRDd 的预测因素，并使用累积定义日剂量（cDDD）评估了 NAC 的效果。
NAC 治疗与进展为 ESRDd 的风险降低相关[风险比（HR），0.819；95%置信区间（CI），0.781-0.965；P=0.017]。与 NAC 未使用者相比，NAC 使用者的风险降低与 cDDD 呈比例关系（cDDD 为 91-180、181-360 和>360 时，HR 分别为 0.835、0.811 和 0.799；P 趋势=0.018）。在女性（P=0.001）和 18-29 岁（P=0.021）和 30-39 岁（P=0.033）的年轻患者中，在高血压（P=0.003）存在的情况下，在没有糖尿病（P=0.042）和充血性心力衰竭（P=0.036）的情况下，风险降低更为明显。
NAC 的使用与进展为 ESRDd 的风险降低相关。这些来自回顾性数据的结果表明，有必要进行前瞻性研究。
