Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki city, Miyazaki, 889-1692, Japan.
Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Miyazaki, Japan.
Clin Exp Nephrol. 2021 Nov;25(11):1215-1223. doi: 10.1007/s10157-021-02094-9. Epub 2021 Jun 15.
Polypharmacy (PP) is common in end-stage chronic renal disease patients largely due to the presence of multiple comorbid conditions. Although PP is potentially harmful, its relationship with mortality and morbidity in hemodialysis patients currently remains unclear.
Study design: cohort study.
participants: one hundred and fifty-two initial hemodialysis patients (male, 88 patients; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at Nobeoka Prefectural Hospital and Chiyoda Hospital.
patients were divided into 2 groups according to PP (6 or more drug prescriptions or less) during admission and discharge for the initiation of hemodialysis.
all-cause mortality and hospitalization during the mean 2.8-year follow-up.
hazard ratios (HRs) were estimated using Cox's model for the relationships between PP and clinical outcomes and adjusted for potential confounders. The group with 5 or less drug prescriptions was set as a reference.
The number of prescribed drugs per patient averaged 7.4 at admission and 7.0 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During the follow-up, 20 patients died and 71 were hospitalized. PP at admission did not correlate with outcomes, whereas that at discharge correlated with all-cause hospitalization.
PP at discharge may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of outcomes or is simply a marker for an increased risk of outcomes.
由于存在多种合并症，终末期慢性肾脏病患者普遍存在多种药物治疗（PP）。尽管 PP 可能有害，但它与血液透析患者的死亡率和发病率之间的关系目前尚不清楚。
研究设计：队列研究。
参与者：2015 年 2 月至 2018 年 3 月期间，在延冈县立医院和千代田医院共招募了 152 名初始血液透析患者（男性 88 例；平均年龄 70.3 岁）。
根据入院和出院时的 PP（6 种或更多药物处方或更少）将患者分为 2 组。
在平均 2.8 年的随访期间，所有原因的死亡率和住院率。
使用 Cox 模型估计 PP 与临床结局之间的关系的风险比（HRs），并调整了潜在的混杂因素。将药物处方 5 种或更少的组设为参考组。
初始血液透析患者入院时平均每人处方 7.4 种药物，出院时平均每人处方 7.0 种药物。入院时和出院时分别有 100 例（65.8%）和 94 例（61.8%）患者存在 PP。在随访期间，20 名患者死亡，71 名患者住院。入院时的 PP 与结局无关，而出院时的 PP 与全因住院相关。
出院时的 PP 可能与临床结局相关。然而，PP 是否是结局的直接原因，还是仅仅是结局风险增加的标志物，尚不清楚。
