老年慢性肾脏病患者肾脏不适当用药评价

Evaluation of renally inappropriate medication in elderly patients with chronic kidney disease

目的:调查分析老年慢性肾脏病(chronic kidney disease,CKD)患者肾脏不适当用药(renally inappropriate medication,RIM)情况及危险因素,为指导老年CKD患者合理用药提供参考。方法:依据Beers标准(2019版),对2016年1月至2020年12月入住北京市某三甲医院的老年CKD患者RIM情况进行回顾性分析,采用多因素Logistic回归分析确定RIM的危险因素。结果:研究共纳入4835例患者,其中595例(12.31%)存在RIM共662项,占比在前3位的药物是螺内酯(69.49%)、磺达肝癸钠(6.65%)和利伐沙班(4.68%)。Logistic回归分析显示,CKD4期及以上、住院时间≥20 d、用药品种数≥10种和心力衰竭是老年CKD住院患者发生RIM的独立危险因素。结论:老年CKD住院患者RIM发生率较高,患者用药合理性有待提升。用药品种数、住院天数、CKD分期和心力衰竭是患者发生RIM的危险因素,临床医师及药师应予以重视。

OBJECTIVE To investigate the prevalence and risk factors of renally inappropriate medication(RIM)in elderly patients with chronic kidney disease(CKD),so as to provide references for improving rational drug use in elderly patients with CKD.METHODS According to the Beers Criteria(2019 version),the RIM of elderly CKD patients hospitalized in a class 3 A hospital in Beijing from January 2016 to December 2020 were retrospectively analyzed.Multivariate Logistic regression analysis was used to analyze the risk factors of RIM.RESULTS A total of 4835 patients were included in the study,of which 595(12.31%)had a total of 662 items of RIM.The top three drugs were spironolactone(69.49%),fondaparinux sodium(6.65%)and rivaroxaban(4.68%).Logistic regression analysis showed that CKD stage 4 or above,length of hospital stay≥20 d,medication type≥10 and heart failure were independent risk factors for RIM.CONCLUSION The prevalence of RIM in elderly inpatients with CKD is high,and the rationality of drug use needs to be improved.The number of drugs used,hospitalization days,CKD stage and heart failure are the risk factors of RIM,which should be paid attention to by clinicians and pharmacists.