在晚期CKD患者中停止或继续使用甲福明:全国性苏格兰向试验仿真研究
Emilie J Lambourg1, Edouard L Fu2, Stuart McGurnaghan3
1Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee.
概括
在晚期病 (CKD) 患者中停止使用甲福明与降低存活率有关. 这项观察性研究表明,继续使用甲福明可能适用于4期CKD的2型糖尿病患者.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 内分泌学 在内分泌学.
- 临床药房 临床药房
背景情况:
- 目前的指导方针经常建议不使用甲胺治疗晚期功能障碍,尽管证据有限.
- 在4期慢性病 (CKD) 的2型糖尿病患者中,继续或停止服用甲福明对死亡率和心血管事件的影响尚不清楚.
研究的目的:
- 为了比较2型糖尿病患者在4期CKD (eGFR<30mL/min/1.73m2) 发展后继续服用甲福尔明或停止服用甲福尔明的结果.
主要方法:
- 在苏格兰 (2010-2019) 全国范围内对2型糖尿病和病发期4期CKD的成年人进行观察队列研究 (2010-2019).
- 使用克隆-传感器重量设计和边缘结构模型进行目标试验模拟.
- 主要结局:全因死亡率. 二级结局:主要心血管不良事件 (MACE).
主要成果:
- 分析包括4278名患者;40.1%的患者在4期CKD诊断后6个月内停止服用甲福明.
- 停止使用甲胺与较低的3年生存率有关 (HR,1.26;95% CI,1.10-1.44).
- 边际结构模型证实,在停止使用甲福明的人群中,所有原因的死亡风险更高 (HR,1.34;95% CI,1.08-1.67) 和类似的MACE风险 (HR,1.04;95% CI,0.81-1.33).
结论:
- 对于患有第四阶段CKD (eGFR<30mL/min/1.73m2) 的患者,继续使用甲福明可能是适当的.
- 停止使用甲福明与生存率的降低有关,而不是由心血管事件的增加解释的.
- 随机对照试验是必要的,以证实这些发现.
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