住院老年慢性肾脏病患者肾脏不适当用药调查及影响因素分析

Survey on renally inappropriate medications in older hospitalized patients with chronic kidney disease and analysis of influencing factors

目的分析住院老年慢性肾脏病(CKD)患者肾脏不适当用药(RIM)的发生情况及相关影响因素,为临床肾脏合理用药提供依据。方法回顾性分析2020年1月至2020年12月某大型综合三甲医院748例住院老年CKD患者的临床资料。利用国内外药品说明书、专家共识、用药手册以及Micromedex数据库等药学工具评估RIM的发生情况。采用SPSS 22.0统计软件进行数据分析。采用多因素logistic回归分析影响RIM的危险因素。结果本研究住院老年CKD患者RIM发生率为50.27%(376/748),共发生RIM 739次。RIM发生频次排名前5的药物类别分别为抗微生物药[46.01%(340/739)]、内分泌系统药[11.77%(87/739)]、泌尿系统药[11.50%(85/739)]、心血管系统药[9.88%(73/739)]及镇痛药[7.31%(54/739)],排名前3的药物品种分别为螺内酯[9.47%(70/739)]、左氧氟沙星[9.34%(69/739)]及头孢哌酮钠舒巴坦钠[7.04%(52/739)]。主要不适当用药情况为肾功能下降时,未调整相关药物剂量。多因素logistic回归分析结果显示,年龄(75~84岁:OR=1.582,95%CI 1.101~2.272,P=0.013;≥85岁:OR=3.026,95%CI 1.532~5.978,P<0.001),药物品种数(11~25种:OR=2.379,95%CI 1.500~3.773,P<0.001;>25种:OR=13.086,95%CI 6.991-24.496,P<0.001),CKD分期(3b期:OR=2.183,95%CI 1.348~3.536,P=0.002;4期:OR=4.287,95%CI 2.485~7.395,P<0.001;5期:OR=4.779,95%CI 2.984~7.654,P<0.001)及查尔森合并症指数(CCI)≥5(OR=2.455,95%CI 1.523~3.957;P<0.001)是患者发生RIM的独立危险因素。结论老年CKD住院患者RIM发生率较高,应重点关注年龄≥75岁、药物品种≥11种、CKD分期≥3b以及CCI≥5的老年CKD患者,以减少RIM的发生。

Objective To analyze the incidence of inappropriate use for renal drugs renally inappropriate medications(RIM)and related influencing factors in elderly inpatients with chronic kidney disease(CKD)in order to provide evidence for rational clinical drug use.Methods The clinical data of 748 elderly patients with CKD hospitalized in a large-scale general hospital from January 2020 to December 2020 were collected and retrospectively analyzed.The occurrence of RIM was evaluated by using pharmaceutical tools such as domestic and foreign drug instructions,expert consensus,medication manuals and Micromedex database.SPSS statistics 22.0 was used for data analysis.Multivariate logistic regression was used to analyze the risk factors of RIM.Results The incidence of RIM was 50.27%(376/748)in the elderly CKD patients,and a total of 739 RIM occurred.The top 5 drug categories of RIM were antimicrobial[46.01%(340/739)],endocrine system drugs[11.77%(87/739)],urinary system drugs[11.50%(85/739)],cardiovascular system drugs[9.88%(73/739)]and analgesics[7.31%(54/739)].The top 3 commonly used drugs were spironolactone[9.47%(70/739)],levofloxacin[9.34%(69/739)],and cefoperazone sodium and sulbactam sodium[7.04%(52/739)].The main inappropriate drug use was that the dose of relevant drugs was not adjusted when the renal function was declined.Multivariate logistic regression analysis showed that age(75-84 years:OR=1.582,95%CI 1.101-2.272;≥85 years:OR=3.026,95%CI 1.532-5.978,P<0.001),number of drug varieties(11-25:OR=2.379,95%CI 1.500-3.773,P<0.001;>25:OR=13.086,95%CI 6.991-24.496,P<0.001),CKD stage(3b stage:OR=2.183,95%CI 1.348-3.536,P=0.002;4 stage:OR=4.287,95%CI 2.485-7.395,P<0.001;5 stage:OR=4.779,95%CI 2.984-7.654,P<0.001)and Charlson comorbidity index(CCI)≥5(OR=2.455,95%CI 1.523-3.957;P<0.001)were independent risk factors for RIM in the CKD patients.Conclusion The incidence of RIM is relatively high in the elderly CKD inpatients.To reduce the occurrence of RIM,the CKD patients≥75 years old,with number of drug varieties≥11,CKD stage≥3b and CCI≥5 should be paid attention to.