Shuto Hisayuki, Omori Shota, Hiramatsu Kazufumi, Kadota Jun-Ichi, Fushimi Kiyohide, Komiya Kosaku
Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu 879-5593, Oita, Japan.
Research Center for Global and Local Infectious Diseases, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu 879-5593, Oita, Japan.
J Clin Med. 2024 Sep 14;13(18):5463. doi: 10.3390/jcm13185463.
Hemodialysis patients are at high risk for developing pneumonia (PJP), and trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for treating this disease. However, there is a lack of consensus on the required dosage of TMP-SMX for hemodialysis patients. This study used the nationwide Japanese Diagnosis Procedure Combination database to review hemodialysis patients hospitalized for PJP from April 2014 to March 2022. Eligible patients were divided into high-dose and low-dose groups based on the median daily dose per body weight of TMP. The 90-day mortality and adverse events after propensity score matching were compared between the groups. A total of 126 hemodialysis patients with PJP were included, and the median daily dose per body weight of TMP was 5.74 mg/kg/day (interquartile range: 4.33-8.18 mg/kg/day). Thirty-two pairs were analyzed after the propensity score matching. No significant differences in the 90-day mortality and proportion of adverse events were observed between the high-dose and low-dose groups. A high dose of TMP-SMX is unlikely to decrease the in-hospital mortality and adverse events among hemodialysis patients with PJP. However, the results should be interpreted with caution, given the lack of power and lack of long-term follow-up. Additional prospective interventional studies are required to validate these results.
血液透析患者发生肺炎（肺孢子菌肺炎，PJP）的风险很高，甲氧苄啶-磺胺甲恶唑（TMP-SMX）是治疗该病的一线药物。然而，对于血液透析患者所需的TMP-SMX剂量，目前尚无共识。本研究利用日本全国诊断程序组合数据库，回顾了2014年4月至2022年3月因PJP住院的血液透析患者。根据TMP的每日每体重中位数剂量，将符合条件的患者分为高剂量组和低剂量组。比较两组倾向评分匹配后的90天死亡率和不良事件。共纳入126例血液透析PJP患者，TMP的每日每体重中位数剂量为5.74 mg/kg/天（四分位间距：4.33-8.18 mg/kg/天）。倾向评分匹配后分析了32对。高剂量组和低剂量组在90天死亡率和不良事件发生率方面未观察到显著差异。高剂量的TMP-SMX不太可能降低血液透析PJP患者的院内死亡率和不良事件。然而，鉴于缺乏效力和长期随访，对结果的解释应谨慎。需要更多的前瞻性干预研究来验证这些结果。
