Lee Szu-Ying, Wang Jui, Tsai Hung-Bin, Chao Chia-Ter, Chien Kuo-Liong, Huang Jenq-Wen
Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.
Ther Adv Drug Saf. 2021 Jun 11;12:20420986211014639. doi: 10.1177/20420986211014639. eCollection 2021.
Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The exposure to muscle relaxants frequently leads to adverse effects despite their modest therapeutic efficacy, but whether muscle relaxants predispose users to frailty remains unclear.
Patients with DKD from a population-based cohort, the Longitudinal Cohort of Diabetes Patients, were identified between 2004 and 2011 ( = 840,000). Muscle relaxant users were propensity score-matched to never-users in a 1:1 ratio based on demographic features, comorbidities, outcome-relevant medications, and prior major interventions. Incident frailty, the study endpoint, was measured according to a modified FRAIL scale. We used Kaplan-Meier analyses and Cox proportional hazard regression to analyze the association between cumulative muscle relaxant use (⩾ 28 days) and the risk of incident frailty.
Totally, 11,637 users and matched never-users were enrolled, without significant differences regarding baseline clinical features. Cox proportional hazard regression showed that patients with DKD and received muscle relaxants had a significantly higher risk of incident frailty than never-users [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.04-1.53]. This increase in frailty risk paralleled that in cumulative muscle relaxant dosages (quartile 1 2 3 4, HR 0.91 1.22 1.38 1.45, = 0.0013 for trend) and in exposure durations (quartile 1 2 3 4, HR 1.12 1.33 1.23 1.34, = 0.0145 for trend) of muscle relaxants.
We found that cumulative muscle relaxant exposure might increase frailty risk. It is prudent to limit muscle relaxant prescription in patients with DKD.
Frailty denotes a degenerative feature that adversely influences one's survival and daily function. Patients with diabetes and chronic kidney disease are at a higher risk of developing frailty, but whether concurrent medications, especially muscle relaxants, aggravate this risk remains undefined. In this population-based study including 11,637 muscle relaxant users and matched never-users with diabetic kidney disease, we used a renowned frailty-assessing tool, FRAIL scale, to assess frailty severity and examined the incidence of frailty brought by muscle relaxant exposure. We found that users exhibited a 26% higher risk of developing incident frailty compared with never-users, and the probability increased further if users were prescribed higher doses or longer durations of muscle relaxants. We concluded that in those with diabetic kidney disease, cumulative muscle relaxant use was associated with a higher risk of incident frailty, suggesting that moderation of muscle relaxant use in this population can be of potential importance.
糖尿病肾病（DKD）患者发生衰弱的风险增加。尽管肌肉松弛剂的治疗效果一般，但使用后常导致不良反应，不过肌肉松弛剂是否会使使用者更易发生衰弱尚不清楚。
在2004年至2011年间，从基于人群的队列“糖尿病患者纵向队列”中识别出DKD患者（n = 840,000）。根据人口统计学特征、合并症、与结局相关的药物以及既往主要干预措施，将肌肉松弛剂使用者与未使用者按1:1的比例进行倾向评分匹配。根据改良的FRAIL量表测量研究终点事件衰弱的发生情况。我们使用Kaplan-Meier分析和Cox比例风险回归分析累积使用肌肉松弛剂（≥28天）与衰弱发生风险之间的关联。
共纳入11,637名使用者和匹配的未使用者，他们在基线临床特征方面无显著差异。Cox比例风险回归显示，患有DKD且使用过肌肉松弛剂的患者发生衰弱的风险显著高于未使用者[风险比（HR）1.26，95%置信区间（CI）1.04 - 1.53]。衰弱风险的增加与肌肉松弛剂的累积剂量（四分位数1、2、3、4，HR分别为0.91、1.22、1.38、1.45，趋势P = 0.0013）和暴露持续时间（四分位数1、2、3、4，HR分别为1.12、1.33、1.23、1.34，趋势P = 0.0145）平行。
我们发现累积暴露于肌肉松弛剂可能会增加衰弱风险。谨慎限制DKD患者使用肌肉松弛剂的处方是明智的。
衰弱是一种退行性特征，会对人的生存和日常功能产生不利影响。糖尿病和慢性肾病患者发生衰弱的风险更高，但同时使用的药物，尤其是肌肉松弛剂，是否会加剧这种风险仍不明确。在这项基于人群的研究中，纳入了11,637名肌肉松弛剂使用者和匹配的未使用糖尿病肾病患者，我们使用著名的衰弱评估工具FRAIL量表评估衰弱严重程度，并研究肌肉松弛剂暴露导致的衰弱发生率。我们发现，与未使用者相比，使用者发生衰弱的风险高出26%，如果使用者使用更高剂量或更长时间的肌肉松弛剂，发生衰弱的概率会进一步增加。我们得出结论，在患有糖尿病肾病的患者中，累积使用肌肉松弛剂与发生衰弱的风险较高有关，这表明在该人群中适度使用肌肉松弛剂可能具有潜在重要性。
