Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Road, Taipei, 112, Taiwan.
Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.
Sci Rep. 2023 Apr 19;13(1):6373. doi: 10.1038/s41598-023-33542-z.
The incidence rates and consequences of inappropriate dosing of glucose-lowering drugs remain limited in patients with chronic kidney disease (CKD). A retrospective cohort study was conducted to estimate the frequency of inappropriate dosing of glucose-lowering drugs and to evaluate the subsequent risk of hypoglycemia in outpatients with an estimated glomerular filtration rate (eGFR) of < 50 mL/min/1.73 m. Outpatient visits were divided according to whether the prescription of glucose-lowering drugs included dose adjustment according to eGFR or not. A total of 89,628 outpatient visits were included, 29.3% of which received inappropriate dosing. The incidence rates of the composite of all hypoglycemia were 76.71 and 48.51 events per 10,000 person-months in the inappropriate dosing group and in appropriate dosing group, respectively. After multivariate adjustment, inappropriate dosing was found to lead to an increased risk of composite of all hypoglycemia (hazard ratio 1.52, 95% confidence interval 1.34, 1.73). In the subgroup analysis, there were no significant changes in the risk of hypoglycemia regardless of renal function (eGFR < 30 vs. 30-50 mL/min/1.73 m). In conclusion, inappropriate dosing of glucose-lowering drugs in patients with CKD is common and associated with a higher risk of hypoglycemia.
在慢性肾脏病（CKD）患者中，降糖药物剂量不当的发生率和后果仍然有限。一项回顾性队列研究旨在评估肾小球滤过率（eGFR）<50 ml/min/1.73 m 的门诊患者中降糖药物剂量不当的频率，并评估随后发生低血糖的风险。根据是否根据 eGFR 调整降糖药物的剂量，将门诊就诊分为两组。共纳入 89628 例门诊就诊患者，其中 29.3%的患者存在剂量不当。在剂量不当组和剂量适当组中，复合所有低血糖事件的发生率分别为每 10000 人月 76.71 和 48.51 例。多变量调整后，发现剂量不当与复合所有低血糖的风险增加相关（危险比 1.52，95%置信区间 1.34，1.73）。亚组分析显示，无论肾功能如何（eGFR<30 与 30-50 ml/min/1.73 m），低血糖风险均无显著变化。总之，CKD 患者降糖药物剂量不当很常见，且与低血糖风险增加相关。
