评估糖尿病和白蛋白尿患者使用血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂的处方。

IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY
Kittiphan Chienwichai, Phirada Chaloemwa, S. Sangkaew, Arunchai Chang
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引用次数: 0

摘要

摘要尽管指南建议糖尿病、高血压和白蛋白尿患者使用血管紧张素转换酶抑制剂(ACEi)或血管紧张素 II 受体阻滞剂(ARB),但在一些发达国家,这些药物的使用仍未达到最佳水平。发展中国家使用 ACEi/ARB 的数据有限。在此,我们对泰国 Hatyai 医院 ACEi/ARB 的使用情况进行了评估,并确定了导致其使用不足的因素。研究纳入了患有糖尿病、高血压和白蛋白尿的成年患者。研究人员提取了临床数据和实验室结果。此外,本研究还记录了影响医生对不遵守指南的患者开具 ACEi/ARBs 处方的预设条件。患者的平均年龄为 66.3 岁,59.6% 为女性。遵守率为 72.4%。多变量逻辑回归分析发现,非依从性与慢性肾病(CKD)分期之间存在显著关联(OR = 1.29,95% CI:1.04 - 1.60,p = 0.019)。导致不坚持用药的最常见的预设病症是 "未确定病症"(69.8%)。在非依从性病例中,21.7%是由于急性肾损伤后停用 ACEi/ARB,其次是高钾血症(5.1%)和血清肌酐中度升高(4.3%)。不坚持治疗与 CKD 分期有关,可能是因为担心不良事件和医疗相关因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with diabetes and albuminuria.
AIM Although guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) in patients with diabetes, hypertension, and albuminuria, their use remains suboptimal in several developed countries. Limited data are available on ACEi/ARB use in developing countries. Here, we assessed the use of ACEi/ARB and identified factors contributing to their underutilization at Hatyai Hospital, Thailand. MATERIALS AND METHODS This retrospective cross-sectional study was conducted using data from the Hatyai Hospital database. Adult patients with diabetes, hypertension, and albuminuria were included. Clinical data and laboratory results were extracted. Furthermore, this study recorded pre-specified conditions that influenced physicians' decisions regarding the prescription of ACEi/ARBs in patients who did not adhere to guidelines. RESULTS Of 4,655 eligible patients, 500 patients were selected. The average age of the patients was 66.3 years, and 59.6% were female. The adherence rate was 72.4%. Multivariate logistic regression analysis found a significant association between non-adherence and chronic kidney disease (CKD) stage (OR = 1.29, 95% CI: 1.04 - 1.60, p = 0.019). The most common pre-specified condition contributing to non-adherence was "no condition identified" (69.8%). Among the cases of non-adherence, 21.7% were due to ACEi/ARB discontinuation after acute kidney injury, followed by hyperkalemia (5.1%) and a moderate increase in serum creatinine (4.3%). CONCLUSION ACEi/ARB therapy was suboptimal in patients with diabetes, hypertension, and albuminuria. Non-adherence was associated with CKD stage, possibly because of concerns about adverse events and healthcare-related factors.
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来源期刊
Clinical nephrology
Clinical nephrology 医学-泌尿学与肾脏学
CiteScore
2.10
自引率
9.10%
发文量
138
审稿时长
4-8 weeks
期刊介绍: Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.
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