停用肾素-血管紧张素系统抑制剂后重新开始使用对肾脏预后和死亡率的影响估计。

IF 10.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Journal of The American Society of Nephrology Pub Date : 2024-10-01 Epub Date: 2024-06-18 DOI:10.1681/ASN.0000000000000425

Koki Hattori, Yusuke Sakaguchi, Tatsufumi Oka, Yuta Asahina, Takayuki Kawaoka, Yohei Doi, Nobuhiro Hashimoto, Yasuo Kusunoki, Satoko Yamamoto, Masafumi Yamato, Ryohei Yamamoto, Isao Matsui, Masayuki Mizui, Jun-Ya Kaimori, Yoshitaka Isaka

引用次数: 0

摘要

背景：虽然肾素-血管紧张素系统抑制剂（RASi）一直是治疗慢性肾脏病患者的主流药物，但由于高钾血症和急性肾损伤等不良反应，这些药物经常被停用。停用 RASi 后重启 RASi 是否能改善临床疗效，目前尚不清楚：我们利用 OCKR（大阪肾脏病研究联合会）数据库开展了一项目标试验模拟研究，研究对象包括 2005 年至 2021 年期间由肾病专家随访并停用 RASi 的 6065 例 eGFR 为 10-60 mL/min/1.73m2 的患者。我们采用克隆张量加权法，比较了停用 RASi 后一年内重启 RASi 和不重启 RASi 的治疗策略。患者在停用 RASi 后最长随访五年。主要结果是综合肾脏结果（开始肾脏替代治疗、eGFR下降≥50%或肾衰竭[eGFR结果：在停用 RASi 的患者中（平均 [标准差 (SD)]] 年龄 66 [15] 岁，62% 为男性，平均 [SD] eGFR 40 [26] ml/min/1.73m2），有 2,262 人（37%）在一年内重新开始使用 RASi。与不重启 RASi 相比，重启 RASi 与较低的肾脏综合结果（危险比 0.85 [95% 置信区间 (CIs) 0.78 至 0.93]）和全因死亡（危险比 0.70 [95% CI 0.61 至 0.80]）相关。两种策略的高钾血症发生率差异不大（危险比 1.11 [95% CI 0.96 至 1.27]）：结论：停药后重启 RASi 与较低的肾脏疾病风险和死亡率相关，但与高钾血症的发生率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Estimated Effect of Restarting Renin-Angiotensin System Inhibitors after Discontinuation on Kidney Outcomes and Mortality.

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来源期刊

Journal of The American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

22.40

自引率

2.90%

发文量

492

审稿时长

3-8 weeks

期刊介绍： The Journal of the American Society of Nephrology (JASN) stands as the preeminent kidney journal globally, offering an exceptional synthesis of cutting-edge basic research, clinical epidemiology, meta-analysis, and relevant editorial content. Representing a comprehensive resource, JASN encompasses clinical research, editorials distilling key findings, perspectives, and timely reviews. Editorials are skillfully crafted to elucidate the essential insights of the parent article, while JASN actively encourages the submission of Letters to the Editor discussing recently published articles. The reviews featured in JASN are consistently erudite and comprehensive, providing thorough coverage of respective fields. Since its inception in July 1990, JASN has been a monthly publication. JASN publishes original research reports and editorial content across a spectrum of basic and clinical science relevant to the broad discipline of nephrology. Topics covered include renal cell biology, developmental biology of the kidney, genetics of kidney disease, cell and transport physiology, hemodynamics and vascular regulation, mechanisms of blood pressure regulation, renal immunology, kidney pathology, pathophysiology of kidney diseases, nephrolithiasis, clinical nephrology (including dialysis and transplantation), and hypertension. Furthermore, articles addressing healthcare policy and care delivery issues relevant to nephrology are warmly welcomed.