老年患者多药治疗与慢性肾脏病发生的相关性分析  

Correlation analysis between polypharmacy and the occurrence of chronic kidney disease in elderly patients

作　　者：李远 严思敏 周海辉 葛卫红 LI Yuan;YAN Si-min;ZHOU Hai-hui;GE Wei-hong(Department of Pharmaceutical,Nanjing Drum Tower Hospital,Nanjing 210000,China)

机构地区：[1]南京鼓楼医院药学部,南京210000

出　　处：《临床药物治疗杂志》2023年第12期75-79,共5页Clinical Medication Journal

摘　　要：目的分析老年患者多药治疗的特点,研究多药治疗与慢性肾脏病(CKD)发生的相关性。方法选取2020年1—12月南京鼓楼医院门诊医院信息系统老年科就诊患者为研究对象,根据服用药物数量分为非多药组(≤4种药物)、多药组(5~9种药物)和超多药组(≥10种药物)3组。采用cox回归模型探讨CKD的发生与多药治疗的相关性。结果最终纳入900例患者,非多药组321例,多药组312例,超多药组267例。两年观察期有222例发生CKD,其中非多药组64例(19.9%),多药组77例(24.7%),超多药组81例(30.3%),超多药组患者发生CKD的风险更高(P<0.05)。多因素cox回归分析显示,高血压(HR=1.475,95%CI:1.226~1.789,P=0.000)、糖尿病(HR=1.511,95%CI:1.115~2.068,P=0.000)、高尿酸血症(HR=1.405,95%CI:1.125~1.756,P=0.001)和服药数量≥10种(HR=1.638,95%CI:1.391~1.997,P=0.000)是老年患者CKD发生的独立危险因素。结论超多药治疗与老年患者CKD发生具有相关性,临床药师应关注合并高血压、糖尿病、高尿酸血症的老年患者,并对其提供针对性的药物治疗管理服务。Objective To analyze the characteristics of polypharmacy for elderly patients at Nanjing Drum Tower Hospital,and study the association between polypharmacy and the occurrence of chronic kidney disease(CKD).Methods Using a prospective study method,geriatric patients in the outpatient hospital information system(HIS)of Nanjing Drum Tower Hospital from January to December 2020 were included in the study.They were divided into three groups according to the number of medications taken:non-polypharmacy treatment group(≤4 drugs),polypharmacy group(5 to 9 drugs)and hyper-polypharmacy group(≥10 drugs).The cox regression model was used to explore the correlation between CKD and multi-drug treatments.Results Nine hundred patients were finally included,including 321 patients in the non-polypharmacy treatment group,312 patients in the polypharmacy group and 267 patients in the hyper-polypharmacy group.During the 2-year observation period,a total of 222 elderly patients developed CKD,including 64 cases(19.9%)in the non-polypharmacy group,77 cases(24.7%)in the polypharmacy group,and 81 cases(30.3%)in the hyper-polypharmacy group.Patients in the hyper-polypharmacy group had a higher risk of developing CKD(P<0.05).Multivariate cox regression analysis showed that hypertension(HR=1.475,95%CI:1.226 to 1.789,P=0.000),diabetes(HR=1.511,95%CI:1.115 to 2.068,P=0.000),hyperuricemia(HR=1.405,95%CI:1.125 to 1.756,P=0.001),the number of drug taken≥10(HR=1.638,95%CI:1.391 to 1.997,P=0.000)were independent risk factors for CKD in elderly patients.Conclusion There is a correlation between hyper-polypharmacy and the occurrence of CKD in elderly patients.Clinical pharmacists should pay attention to this population and provide more targeted drug treatment management services.

关 键 词：老年患者 多药治疗 超多药治疗 慢性肾脏病 

分 类 号：R969.3[医药卫生—药理学]