摘要
背景 慢性肾病(chronic kidney disease,CKD)患者由于自身疾病和不适当用药等原因更易发生药品不良反应(adverse drug reaction,ADR),减少CKD患者不适当用药,预防ADR的发生具有重要的临床意义。目的 分析CKD患者ADR的发生特点和肾不适当用药(renally inappropriate medication,RIM)的发生率,为CKD患者临床合理用药提供参考。方法 分析2009-2021年解放军总医院第一医学中心肾病科上报的ADR报告,统计患者基本情况、CKD分期、药物种类、ADR累及系统和器官等,并根据药品说明书及相关指南和专家共识评估ADR报告中RIM的发生情况。结果 本研究共纳入629例CKD患者的ADR报告(严重ADR报告93例),男女比例为1.18∶1,以40~59岁ADR例数最多。引发ADR频次较多的为心血管系统药物、抗感染药物、电解质/酸碱平衡/营养药物。累及系统-器官共849例,主要涉及胃肠道系统损害156例(18.37%),皮肤及皮肤附件损害139例(16.37%),全身性损害107例(12.60%)。ADR报告中共发现61例(9.69%)RIM,涉及严重ADR报告19例(31.15%)。RIM发生频次最高的药品和RIM涉及严重ADR最多的药品均为左氧氟沙星。结论 CKD患者ADR涉及药物品种较多,累及多个系统和器官,部分ADR与RIM有关,应加强CKD患者用药监测,减少肾不适当用药,尤其关注抗感染药物和心血管系统药物,并谨慎使用肾毒性药物。
Background Patients with chronic kidney disease(CKD) are more prone to have adverse drug reaction(ADR) due to their own diseases and inappropriate medication. It is of great clinical significance to reduce inappropriate medication and to prevent ADR for CKD. Objective To analyze ADRs occurred in CKD patients and the renally inappropriate medication(RIM) for providing reference to rational drug use in patients with CKD. Methods ADRs reported by the nephrology department in our hospital from 2009 to 2021 were analyzed, including the basic information of patients, CKD stages, drug types, and the involved system/organs.The occurrence of RIMs in ADR reports were evaluated according to the drug instructions, relevant guidelines and expert consensus.Results A total of 629 ADRs were included, including 93 severe ADRs, with a male to female ratio of 1.18:1, and they occurred most frequently in CKD with age of 40-59 years. The top three categories of ADRs were cardiovascular drugs, anti-infective drugs,electrolyte, acid-base balance and nutritional drugs. Many systemic/organs(849 cases) were involved, the top three were gastrointestinal disorders(156 cases, 18.37%), skin and appendages disorder(139 cases, 16.37%), body as a whole-general disorders(107 cases, 12.60%). A total of 61(9.69%) RIMs were found in ADR reports, including 19(31.15%) serious ADRs. Levofloxacin was the most common drug both of RIM and serious ADR in RIM. Conclusion There are multiple drugs and systems/organs involved in ADR of CKD patients, and part of them are related to RIM. Therefore, we should strengthen medication monitoring in CKD patients and reduce RIMs, especially when we use the anti-infective, cardiovascular, and nephrotoxic drugs.
作者
王瑾
刘悦
高奥
李晨
陈孟莉
WANG Jin;LIU Yue;GAO Ao;LI Chen;CHEN Mengli(Chinese PLA Medical School,Beijing 100853,China;Department of Pharmacy,Chinese PLA General Hospital,Beijing 100853,China;Center of Translational Medicine Research,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
北大核心
2023年第1期6-10,16,共6页
Academic Journal of Chinese PLA Medical School
基金
国家重点研发计划(2020YFC2005005)
军队保健专项科研课题(21BJZ36)。
关键词
药品不良反应
慢性肾病
肾不适当用药
抗感染药物
心血管系统药物
adverse drug reaction
chronic kidney disease
renally inappropriate medication
anti-infective drug
cardiovascular drug
