心力衰竭住院风险与终末期肾病与地高辛在心脏-肾脏综合征患者中的使用：基于人群的研究。
Association between the risk of heart failure hospitalization and end-stage renal disease with digoxin usage in patients with cardiorenal syndrome: A population-based study.
机构信息
Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
Front Public Health. 2023 Jan 17;10:1074017. doi: 10.3389/fpubh.2022.1074017. eCollection 2022.
BACKGROUND
The management of the coexistence of heart disease and kidney disease is increasingly challenging for clinicians. Chronic kidney disease (CKD) is not only a prevalent comorbidity of patients with heart failure but has also been identified as a noteworthy risk factor for all-cause mortality and poor clinical outcomes. Digoxin is one of the commonest treatments for heart disease. There are few trials investigating the role of digoxin in patients with cardiorenal syndrome (CRS). This study aims to examine the association between digoxin usage and clinical outcomes in patients with CRS in a nationwide cohort.
METHOD
We conducted a population-based study that included 705 digoxin users with CRS; each patient was age, sex, comorbidities, and medications matched with three non-users who were randomly selected from the CRS population. Cox proportional hazards regression analysis was conducted to estimate the effects of digoxin on the incidence of all-cause mortality, congestive heart failure (CHF) hospitalization, coronary artery disease (CAD) hospitalization, and end-stage renal disease (ESRD).
RESULTS
The all-cause mortality rate was significantly higher in digoxin users than in non-users (adjusted hazard ratio [aHR] = 1.26; 95% confidence interval [CI] = 1.09-1.46, = ). In a subgroup analysis, there was significantly high mortality in the defined daily dose (DDD) subgroup of digoxin users (aHR = 1.49; 95% CI = 1.23-1.82, <). Thus, the was . With digoxin prescription, the CHF hospitalization was significantly higher [subdistribution HR (sHR) = 1.17; 95% CI = 1.05-1.30, = ], especially in the > subgroup (sHR = 1.19; 95% CI = 1.01-1.41, = = ). The digoxin usage lowered the coronary artery disease (CAD) hospitalization in the > subgroup (sHR = 0.79; 95% CI = 0.63-0.99, = ). In renal function progression, more patients with CRS entered ESRD with digoxin usage (sHR = 1.34; 95% CI = 1.16-1.54, <). There was a significantly greater incidence of ESRD in the < and - subgroups of digoxin users (sHR = 1.32; 95% CI = 1.06-1.66, = ; sHR = 1.44; 95% CI = 1.18-1.75; <).
CONCLUSION
Digoxin should be prescribed with caution to patients with CRS.
背景
心脏病和肾脏病并存的管理对临床医生来说越来越具有挑战性。慢性肾脏病（CKD）不仅是心力衰竭患者常见的合并症，而且已被确定为全因死亡率和不良临床结局的显著危险因素。地高辛是治疗心脏病最常用的药物之一。很少有试验研究地高辛在心力肾综合征（CRS）患者中的作用。本研究旨在通过全国性队列研究，研究地高辛使用与 CRS 患者临床结局之间的关系。
方法
我们进行了一项基于人群的研究，纳入了 705 例 CRS 地高辛使用者；每位患者按年龄、性别、合并症和药物与从 CRS 人群中随机选择的 3 名非使用者相匹配。使用 Cox 比例风险回归分析估计地高辛对全因死亡率、充血性心力衰竭（CHF）住院、冠心病（CAD）住院和终末期肾病（ESRD）发生率的影响。
结果
地高辛使用者的全因死亡率明显高于非使用者（调整后的危险比[aHR] = 1.26；95%置信区间[CI] = 1.09-1.46， = ）。在亚组分析中，地高辛使用者的定义日剂量（DDD）亚组死亡率明显升高[aHR = 1.49；95%CI = 1.23-1.82， <]。因此， 。有地高辛处方时，心力衰竭住院率显著升高[亚分布风险比（sHR）= 1.17；95%CI = 1.05-1.30， = ]，特别是 > 亚组（sHR = 1.19；95%CI = 1.01-1.41， = = ）。地高辛的使用降低了 > 亚组的冠心病（CAD）住院率（sHR = 0.79；95%CI = 0.63-0.99， = ）。在肾功能进展方面，地高辛使用者中有更多的 CRS 患者进入 ESRD （sHR = 1.34；95%CI = 1.16-1.54， <）。地高辛使用者中，< 和 - 亚组的 ESRD 发生率显著升高（sHR = 1.32；95%CI = 1.06-1.66， = ；sHR = 1.44；95%CI = 1.18-1.75； <）。
结论
地高辛应谨慎用于 CRS 患者。
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