肾移植受者的多重用药与虚弱状态

Hyperpolypharmacy and Frailty in Kidney Transplant Recipients.

作者信息

Kosoku Akihiro, Iwai Tomoaki, Kabei Kazuya, Nishide Shunji, Maeda Keiko, Kumada Norihiko, Uchida Junji

机构信息

Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.

出版信息

Transplant Proc. 2022 Mar;54(2):367-373. doi: 10.1016/j.transproceed.2021.11.026. Epub 2022 Jan 13.

DOI:10.1016/j.transproceed.2021.11.026

PMID:35033367

Abstract

BACKGROUND

Kidney transplant recipients (KTRs) take multiple medications including immunosuppressants every day. Although polypharmacy is associated with frailty, the situation remains unknown in KTRs. The aim of the present study is to investigate the association between hyperpolypharmacy and frailty in KTRs.

METHODS

This study was a single-center, cross-sectional investigation carried out on KTRs between August 2018 and February 2019 at Osaka City University Hospital. Frailty was evaluated using the Kihon Checklist (KCL). The number of medications was determined from the regular medicines the participants took by mouth every day. Hyperpolypharmacy was defined as 10 or more medications. Statistical analyses were performed using multivariable logistic regression analyses and multivariable linear regression analyses.

RESULTS

Of 211 KTRs enrolled in this study, the mean (SD) number of medicines taken orally regularly was 9.4 (3.4), and hyperpolypharmacy participants accounted for 41%. Hyperpolypharmacy was associated with both the total KCL score (odds ratio, 1.13; P = .016) and being frail compared with being robust (odds ratio, 5.70; P = .007) after adjustments for age, sex, and body mass index. The number of medications was associated with both the total KCL score (β = 0.20; P < .001) and being frail compared with being robust (β = 2.51; P < .001) after adjustments for age, sex, body mass index, dialysis vintage, time after transplant, serum albumin, and estimated glomerular filtration rate. The optimal cutoff value for the number of medications to detect frailty was 12 (area under the curve, 0.81).

CONCLUSIONS

In KTRs, hyperpolypharmacy was prevalent and was associated with frailty.

摘要

背景

肾移植受者（KTRs）每天需要服用多种药物，包括免疫抑制剂。尽管多重用药与身体虚弱有关，但在KTRs中这种情况仍不清楚。本研究的目的是调查KTRs中多重用药与身体虚弱之间的关联。

方法

本研究是一项单中心横断面调查，于2018年8月至2019年2月在大阪市立大学医院对KTRs进行。使用简易检查表（KCL）评估身体虚弱情况。通过参与者每天口服的常规药物确定用药数量。多重用药定义为服用10种或更多药物。使用多变量逻辑回归分析和多变量线性回归分析进行统计分析。

结果

在本研究纳入的211名KTRs中，常规口服药物的平均（标准差）数量为9.4（3.4），多重用药参与者占41%。在对年龄、性别和体重指数进行调整后，多重用药与KCL总分（比值比，1.13；P = 0.016）以及与身体强壮相比身体虚弱（比值比，5.70；P = 0.007）均相关。在对年龄、性别、体重指数、透析龄、移植后时间、血清白蛋白和估计肾小球滤过率进行调整后，用药数量与KCL总分（β = 0.20；P < 0.001）以及与身体强壮相比身体虚弱（β = 2.51；P < 0.001）均相关。检测身体虚弱的用药数量的最佳截断值为12（曲线下面积，0.81）。