骨质疏松症透析患者的登诺苏马布和心血管风险:一项回顾性队列研究
Justin Riley Lam1,2, Emmanuel Otabor1,2, Laith Alomari1,2
1Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA.
概括
与双酸盐相比,在患有骨质疏松症的透析患者中使用德诺苏马布会增加心血管风险和低血症. 骨折保护并不优越,需要对这个高风险群体进行仔细的风险效益评估.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
背景情况:
- 骨质疏松症在透析患者中很普遍,但在晚期脏疾病中,由于安全问题,治疗受到限制.
- 德诺苏马布提供非脏清除选项,但其心血管安全概况在这个人群中尚未得到充分确立.
研究的目的:
- 为了比较denosumab与口服双酸盐在患有骨质疏松症的透析患者的心血管安全性和疗效.
- 评估主要不良心血管事件 (MACE),低热血症,骨折和死亡率的风险.
主要方法:
- 使用来自139个医疗保健组织的TrinetX全球协作网络数据进行了回顾性队列研究.
- 包括患有骨质疏松症和末期脏病的成年人 (≥50岁),接受透析,接受德诺苏马布或口服双酸盐治疗.
- 倾向性得分匹配 (1:1) 和考克斯比例危险模型用于分析结果.
主要成果:
- 代诺苏马布与MACE (HR: 1.690) 和低血症 (HR: 2.247) 的风险显著增加有关.
- 特定的MACE成分,包括心肌梗塞和心力衰竭,也在denosumab中升高.
- 在两个治疗组之间,没有观察到骨折发生率或因任何原因死亡率的显著差异.
结论:
- 与双酸盐相比,登诺苏马布可能会增加透析患者患有骨质疏松症的心血管和电解质相关风险.
- 这项研究没有明确的证据表明,在这个人群中,德诺苏马布对骨折的保护优越.
- 仔细的风险益处评估至关重要,需要进一步的前性研究来确认安全性和有效性.
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