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在CKD的3-5阶段, thiazide利尿剂与循环利尿剂对比:对心脏和脏结局的影响
Li-Chin Sung1,2,3,4,5, Hui-Wen Chiu5,6,7,8, Samuel Mon-Wei Yu9
1Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Postgraduate medicine
|August 27, 2024
概括
在患有晚期慢性病 (CKD) 和高血压的患者中使用循环利尿剂会增加死亡率和心脏病发作事件. thiazide 利尿剂没有显示任何不良关联,但联合治疗增加了死亡风险.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 有限的数据存在于利尿剂的使用和在3-5期慢性病 (CKD) 和高血压中的心脏结局.
- 了解不同类型的利尿剂的影响对于管理这些高风险患者至关重要.
研究的目的:
- 研究特定利尿剂类 (循环与 thiazide) 的长期临床影响,对接受 ACE 抑制剂或 ARB 治疗的 3-5 期CKD 和高血压的台湾患者进行研究.
- 分析与所有原因死亡率,心血管死亡和心脏脏不良事件的关联.
主要方法:
- 使用台湾国家医疗保险研究数据库 (2008-2019) 进行的回顾性队列研究.
- 包括在ACEI/ARB (2010-2018) 上的3-5期CKD患者.
- 倾向性得分匹配和考克斯回归分析了非利尿剂,循环 (富洛塞米德), thiazide 和组合利尿剂组的结果.
主要成果:
- 循环利尿剂 (furosemide) 的使用与心力衰竭,急性功能衰竭,末期病,心血管死亡率和全因死亡率 (p<0.001) 的住院住院风险增加显著相关.
- 单独使用 thiazide 利尿剂没有显示任何不良结果关联.
- 结合疗法 (thiazide + furosemide) 与非利尿剂, thiazide 或 furosemide 单一疗法相比,与更高的全因死亡率有关 (p<0.001).
结论:
- 在接受ACEI/ARB治疗的3-5期CKD患者中使用循环利尿剂与增加的死亡率和心脏病发作事件有关.
- 单独使用的 thiazide 利尿剂没有显示任何不良关联.
- 需要进一步的随机对照试验来确认安全性,并指导在这个人群中处方循环利尿剂.
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