慢性肾脏病患者的用药现状调查及分析

Survey and analysis of current status of drug use in patients with chronic kidney disease(CKD)

目的 调查慢性肾脏病患者的多重用药情况,识别药物相关问题,为临床药师参与药物治疗管理提供参考。方法 采用连续抽样,通过合理用药监测系统(PASS)抽取2021年1-3月在河南省人民医院肾内科住院的慢性肾脏病患者。对慢性肾脏病的分期、合并症和多重用药情况进行分类统计,分析慢性肾脏病患者的用药特点,评价多重用药(≥5种用药)治疗现状。使用欧洲药学监护联盟分类系统(PCNE)对慢性肾脏病患者的药物相关问题进行分类及记录。结果 共纳入582例慢性肾脏病患者,98.72%为慢性肾脏病3~5期,平均罹患疾病(6.23±2.64)种;主要的合并慢性病为高血压(73.53%)、肾性贫血(63.06%)、继发性甲状旁腺功能亢进(36.60%)及糖尿病(23.37%)。住院期间用药品种4~16种,平均(10.02±2.92)种,出院后患者长期用药品种为3~12种,平均(7.76±2.21)种。院外长期服药患者中,95.35%存在多重用药,常见药物种类有抗高血压药(73.54%)、抗贫血药(63.06%)、抗凝药(50.34%)、钙调节药(36.94%)及降糖药(23.37%)。进一步通过PCNE分类系统,从性质上明确药物相关问题,为个体化药学监护提供参考。结论 慢性肾脏病患者共患病种类多,多重用药发生率高,由此带来的药物相关问题发生风险较高。提示临床药师应积极实施药物治疗管理,为患者提供个体化用药监护,降低用药风险,促进合理用药。

Objective To investigate the polypharmacy and to identify the drug-related problems(DRPs)associated with the therapy for chronic kidney disease(CKD)patients in order to provide reference for clinical pharmacist to participate in drug therapy.Methods Continuous sampling was used to select patients with chronic kidney disease who were hospitalized in the Department of Nephrology,Henan Provincial People′s Hospital from January to March 2021 through the prescription automatic screening system(PASS).The stages,comorbidities and polypharmacy of chronic kidney disease were classified and counted,the characteristics of drugs used in patients with chronic kidney disease were analyzed,and the current status of polypharmacy(≥5 drugs)was evaluated.Drug-related problems were classified and documented using the PCNE classification system.Results A total of 582 patients with chronic kidney disease were included,and 98.72%had chronic kidney disease stage 3-5,with an average of(6.23±2.64)diseases.The main complicated chronic diseases were hypertension(73.53%),renal anemia(63.06%),secondary hyperparathyroidism(36.60%)and diabetes(23.37%).There were 4-16 kinds of medication during hospitalization,with an average of(10.02±2.92),and 3-12 kinds of long-term medication after discharge,with an average of(7.76±2.21).Multiple drug uses were observed in 95.35%of the patients with long-term medication for chronic diseases,antihypertention drugs were the most commonly used drugs(73.54%),followed by anti-anemia drugs(63.06%),anticoagulant drugs(50.34%),calcium regulatory drugs(36.94%)and hypoglycemic drugs(23.37%).Through the PCNE classification system,the drug-related problems were further clarified to provide a reference for individualized pharmaceutical care.Conclusion There are many types of comorbidities in patients with chronic kidney disease,the incidence of polypharmacy is high,and the risk of drug-related problems is high.It is suggested that clinical pharmacists should actively implement drug treatment management,provide individualized medication monitoring,reduce medication risks,and promote rational drug use.