From the Division of Nephrology (Y.-C.W., K.-L.K.), Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine (Y.-C.W., W.-H.T., K.-L.K.), Buddhist Tzu Chi University, Hualien, Taiwan.
Department of Ophthalmology (X.C.L.), Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
Am J Ophthalmol. 2023 Sep;253:49-55. doi: 10.1016/j.ajo.2023.05.007. Epub 2023 May 5.
To investigate the risks of metabolic acidosis and renal outcomes after topical carbonic anhydrase inhibitor (CAI) use in patients with both primary open-angle glaucoma (POAG) and advanced chronic kidney disease (CKD).
Nationwide, population-based cohort study.
This study was conducted with population data from Taiwan's National Health Insurance (NHI) Research Database between January 2000 and June 2009. Patients with advanced CKD who were diagnosed with glaucoma (International Classification of Diseases, Ninth Revision [ICD-9] code 365) and had been receiving eye drops for glaucoma (including carbonic anhydrase inhibitors selected by NHI drug code) were enrolled. Using Kaplan-Meier methods, we compared the cumulative incidence of mortality, long-term dialysis, and cumulative incidence of metabolic acidosis over time between CAI users and CAI non-users. Primary outcomes comprised mortality, renal outcome (progression to hemodialysis), and metabolic acidosis.
In this cohort, topical CAI users had a higher incidence of long-term dialysis than non-users (incidence = 1,216.85 vs 764.17 events per 100 patient-years; adjusted hazard ratio = 1.17, 95% CI = 1.01-1.37). Hospital admissions due to metabolic acidosis were higher in CAI users compared with non-users (incidence = 21.54 vs 11.87 events per 100 patient-years; adjusted hazard ratio = 1.89, 95% CI = 1.07-3.36).
Topical CAIs may be associated with higher risks of long-term dialysis and metabolic acidosis in patients with POAG and pre-dialysis advanced CKD. Therefore, topical CAIs should be used with caution in advanced CKD patients.
探讨原发性开角型青光眼（POAG）合并晚期慢性肾脏病（CKD）患者局部碳酸酐酶抑制剂（CAI）使用后代谢性酸中毒和肾脏结局的风险。
全国范围内基于人群的队列研究。
本研究使用了台湾全民健康保险（NHI）研究数据库 2000 年 1 月至 2009 年 6 月的人群数据。纳入患有晚期 CKD 且被诊断为青光眼（国际疾病分类第 9 版[ICD-9]代码 365）并接受过眼部青光眼滴注治疗（包括 NHI 药物代码选择的 CAI）的患者。采用 Kaplan-Meier 方法比较 CAI 使用者和非使用者在不同时间点的死亡率、长期透析和代谢性酸中毒的累积发生率。主要结局包括死亡率、肾脏结局（进展为血液透析）和代谢性酸中毒。
在该队列中，局部 CAI 使用者的长期透析发生率高于非使用者（发生率=1216.85 与 764.17 例/100 患者年；调整后的危险比=1.17，95%可信区间=1.01-1.37）。CAI 使用者因代谢性酸中毒住院的人数高于非使用者（发生率=21.54 与 11.87 例/100 患者年；调整后的危险比=1.89，95%可信区间=1.07-3.36）。
局部 CAI 可能与 POAG 和预透析晚期 CKD 患者长期透析和代谢性酸中毒的风险增加相关。因此，在晚期 CKD 患者中应谨慎使用局部 CAI。
