Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Am J Nephrol. 2018;47(6):441-449. doi: 10.1159/000489703. Epub 2018 Jun 12.
Various medications are cleared by the kidneys, therefore patients with impaired renal function, especially dialysis patients are at risk for adverse drug events (ADEs). There are limited studies on ADEs in maintenance dialysis patients.
We utilized a nationally representative database, the Nationwide Emergency Department Sample, from 2008 to 2013, to compare emergency department (ED) visits for dialysis and propensity matched non-dialysis patients. Log binomial regression was used to calculate relative risk of hospital admission and logistic regression to calculate ORs for in-hospital mortality while adjusting for patient and hospital characteristics.
While ED visits for ADEs decreased in both groups, they were over 10-fold higher in dialysis patients than non-dialysis patients (65.8-88.5 per 1,000 patients vs. 4.6-5.4 per 1,000 patients respectively, p < 0.001). The top medication category associated with ED visits for ADEs in dialysis patients is agents primarily affecting blood constituents, which has increased. After propensity matching, patient admission was higher in dialysis patients than non-dialysis patients, (88 vs. 76%, p < 0.001). Dialysis was associated with a 3% increase in risk of admission and 3 times the odds of in-hospital mortality (adjusted OR 3, 95% CI 2.7-2.3.3).
ED visits for ADEs are substantially higher in dialysis patients than non-dialysis patients. In dialysis patients, ADEs associated with agents primarily affecting blood constituents are on the rise. ED visits for ADEs in dialysis patients have higher inpatient admissions and in-hospital mortality. Further studies are needed to identify and implement measures aimed at reducing ADEs in dialysis patients.
各种药物通过肾脏清除，因此肾功能受损的患者，尤其是透析患者，存在发生药物不良事件（ADE）的风险。维持性透析患者的 ADE 研究有限。
我们利用了一个全国代表性的数据库，即 2008 年至 2013 年的全国急诊部样本，比较了透析和倾向匹配的非透析患者的急诊部（ED）就诊情况。采用对数二项式回归计算住院率的相对风险，采用逻辑回归计算住院死亡率的比值比（OR），同时调整患者和医院特征。
虽然两组的 ED 就诊 ADE 都有所减少，但透析患者的就诊率仍比非透析患者高 10 多倍（分别为 65.8-88.5/1000 患者和 4.6-5.4/1000 患者，p<0.001）。与透析患者 ED 就诊 ADE 相关的首要药物类别是主要影响血液成分的药物，该类药物的就诊率有所增加。在倾向匹配后，透析患者的住院率高于非透析患者（88%比 76%，p<0.001）。透析患者的住院风险增加 3%，住院死亡率增加 3 倍（调整后的 OR 3，95%可信区间 2.7-2.3）。
透析患者的 ED 就诊 ADE 明显高于非透析患者。在透析患者中，主要影响血液成分的药物相关 ADE 呈上升趋势。透析患者的 ED 就诊 ADE 有更高的住院率和住院死亡率。需要进一步研究，以确定并实施旨在减少透析患者 ADE 的措施。
