通便剂的使用与晚期慢性肾脏病患者估算肾小球滤过率的变化。
Laxative Use and Change in Estimated Glomerular Filtration Rate in Patients With Advanced Chronic Kidney Disease.
机构信息
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee.
出版信息
J Ren Nutr. 2021 Jul;31(4):361-369. doi: 10.1053/j.jrn.2020.08.005. Epub 2020 Sep 18.
OBJECTIVES
Constipation is highly prevalent in advanced chronic kidney disease (CKD), due in part to dietary (e.g., fiber) restrictions, and is often managed by laxatives; however, the effect of laxative use on kidney function in advanced CKD remains unclear. We aimed to examine the association of laxative use with longitudinal change in estimated glomerular filtration rate (eGFR) in patients with advanced CKD.
DESIGN AND METHODS
In a retrospective cohort of 43,622 US veterans transitioning to end-stage renal disease (ESRD) from 2007 to 2015, we estimated changes in eGFR (slope) by linear mixed-effects models using ≥2 available outpatient eGFR measurements during the 2-year period before transition to ESRD. The association of laxative use with change in eGFR was examined by testing the interaction of time-varying laxative use with time for eGFR slope in the mixed-effects models with adjustment for fixed and time-varying confounders.
RESULTS
Laxatives were prescribed in 49.8% of patients during the last 2-year pre-ESRD period. In the crude model, time-varying laxative use was modestly associated with more progressive eGFR decline compared with non-use of laxatives (median [interquartile interval] -7.1 [-11.9, -4.3] vs. -6.8 [-11.6, -4.0] mL/min/1.73 m/year, P < .001). After multivariable adjustment, a faster eGFR decline associated with laxative use (vs. non-use of laxatives) remained statistically significant, although the between-group difference in eGFR slope was minimal (median [interquartile interval] -8.8 [-12.9, -5.9] vs. -8.6 [-12.6, -5.6] mL/min/1.73 m/year, P < .001). The significant association was no longer evident across different types of laxatives (i.e., stool softeners, stimulants, or hyperosmotics).
CONCLUSIONS
There was a clinically negligible association of laxative use with change in eGFR during the last 2-year pre-ESRD period, suggesting the renal safety profile of laxatives in advanced CKD patients.
目的
由于饮食（例如纤维）限制，晚期慢性肾脏病（CKD）患者中便秘的发病率很高，且通常通过泻药进行治疗；然而，在晚期 CKD 患者中，泻药的使用对肾功能的影响仍不清楚。我们旨在研究晚期 CKD 患者中，泻药的使用与估算肾小球滤过率（eGFR）的纵向变化之间的关系。
设计和方法
在 2007 年至 2015 年期间从 CKD 向终末期肾病（ESRD）过渡的 43622 名美国退伍军人的回顾性队列中，我们使用线性混合效应模型通过在向 ESRD 过渡前的 2 年内≥2 次可用的门诊 eGFR 测量值来估计 eGFR（斜率）的变化。通过在混合效应模型中测试时变的泻药使用与 eGFR 斜率的时间之间的交互作用，来检查泻药的使用与 eGFR 变化之间的关系，该模型调整了固定和时变混杂因素。
结果
在最后 2 年的 ESRD 前期间，有 49.8%的患者开具了泻药。在未校正模型中，与不使用泻药相比，时变的泻药使用与 eGFR 更显著的下降相关（中位数[四分位距]：-7.1[-11.9，-4.3] vs. -6.8[-11.6，-4.0]mL/min/1.73m/year，P<.001）。经过多变量调整后，与使用泻药（与不使用泻药相比）相关的 eGFR 下降速度仍然具有统计学意义，尽管两组之间的 eGFR 斜率差异较小（中位数[四分位距]：-8.8[-12.9，-5.9] vs. -8.6[-12.6，-5.6]mL/min/1.73m/year，P<.001）。在不同类型的泻药（即大便软化剂、兴奋剂或高渗剂）中，这种显著的关联不再明显。
结论
在 ESRD 前的最后 2 年中，泻药的使用与 eGFR 的变化之间存在临床可忽略的关联，这表明在晚期 CKD 患者中，泻药的肾脏安全性良好。
Zotero 插件