抗抑郁药在患有CKD的成年人中的比较安全性
Nanbo Zhu1, Hong Xu2, Tyra Lagerberg1,3
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Clinical journal of the American Society of Nephrology : CJASN
|November 30, 2023
概括
慢性病 (CKD) 患者使用抗抑郁药物显示了骨折等短期风险,但没有长期危害. 与SSRI相比,米尔塔萨平与胃肠道出血减少有关,但死亡风险较高.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 精神病学是一个精神病学.
- 临床药理学 临床药理学
背景情况:
- 抑郁症在慢性病 (CKD) 患者中很常见,预后恶化.
- 在CKD患者中,抗抑郁药的安全性尚未得到充分证实.
- 慢性病影响全球大约10%的人口.
研究的目的:
- 评估抗抑郁药治疗在CKD患者中的安全性和有效性.
- 为了在这个人群中比较不同的抗抑郁药策略.
- 为临床实践提供关于慢性脏病中抑郁症管理的信息.
主要方法:
- 使用斯德哥尔摩肌素测量项目 (2007-2019) 进行的回顾性队列研究.
- 确定的成年人患有CKD G3-5阶段 (eGFR <60毫升/分钟/1.73米2) 和发生抑郁症.
- 采用向试验仿真来比较抗抑郁药的启动,米尔塔扎与SSRI,以及SSRI剂量策略.
主要成果:
- 开始服用抗抑郁药与短期风险增加有关 (关节骨折,胃肠道出血),尽管在统计学上不显著.
- 在抗抑郁药的使用和长期结果 (死亡率,MACE,CKD进展,自杀行为) 之间没有发现显著的关联.
- 米尔塔扎的消化道出血风险较低,但死亡风险高于SSRI;低剂量SSRI的消化道出血和CKD进展趋势不显著,但心脏骤停风险增加.
结论:
- 在CKD患者中,抗抑郁药治疗与短期不良事件有关.
- 在这个队列中,在使用抗抑郁药时没有观察到任何显著的长期不良结果.
- 需要进一步的研究来优化抗抑郁药的选择和剂量在CKD.
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