■高血容量是慢性肾脏病(CKD)患者普遍存在的合并症。噻嗪类利尿剂(THZ)是容量超负荷和高血压(HTN)的最常见治疗方法。本研究调查了全国范围内CKD患者THz使用与临床结果之间的关联。
■研究中的患者总数为24,312。在与从CKD人群中随机选择的一个非用户匹配后,我们在THZ和比较队列中确定了8501例患者.进行Cox比例风险回归分析以估计THz与全因死亡率的相关性。终末期肾病(ESRD),充血性心力衰竭(CHF),急性心肌梗死(AMI),外周动脉闭塞性疾病(PAOD),和中风。
■THz使用者的全因死亡率明显低于非使用者(风险比[HR]=0.65,95%置信区间[CI]=0.60-0.71)。使用THZ与ESRD的发生率较低相关,AMI,PAOD,和卒中(P<0.05)。在亚组分析中,一些显著的临床结局与CKD3期和4期相关(P<0.05);CKD5期没有临床相关性.在进一步的THz亚型分析中,与较少的死亡有临床联系,ESRD,AMI,和伴随氯噻酮处理的PAOD。此外,因为他的处方与降低死亡率有关,ESRD,AMI,和PAOD患病率。然而,ESRD的发生率明显更高,CHF,和AMI中的速溶酮用户。
■使用THZ与较低的死亡率和ESRD发生率相关,AMI,PAOD,CKD3期和4期患者的卒中。
UNASSIGNED: Hypervolemia is a prevalent comorbidity of chronic kidney disease (CKD) patients. Thiazide diuretics (THZ) are the most common treatment for volume overload and hypertension (HTN). This study examines the association between THZ usage and clinical outcomes among CKD patients in a nationwide cohort.
UNASSIGNED: The total number of patients in the study was 24,312. After matching with one non-user randomly selected from the CKD population, we identified 8501 patients in the THZ and the comparison cohorts. Cox proportional hazards regression analysis was conducted to estimate the associations of THZ on the incidence of all-cause mortality, end-stage renal disease (ESRD), congestive heart failure (CHF), acute myocardial infarction (AMI), peripheral arterial occlusive disease (PAOD), and stroke.
UNASSIGNED: The all-cause mortality rate was significantly lower in THZ users than in non-users (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.60- 0.71). The THZ usage was associated with a lower incidence of ESRD, AMI, PAOD, and stroke (P<0.05). In subgroup analysis, some significant clinical outcomes were related with CKD stages 3 and 4 (P<0.05); however, there were no clinical associations in CKD stage 5. In further THZ subtype analysis, there were clinical associations with fewer deaths, ESRD, AMI, and PAOD accompanying chlorthalidone treatment. Moreover, the indapamide prescription was linked to lower mortality, ESRD, AMI, and PAOD prevalence. However, there were significantly greater incidences of ESRD, CHF, and AMI in the metolazone users.
UNASSIGNED: THZ usage is associated with lower mortality and incidence of ESRD, AMI, PAOD, and stroke s in patients with CKD stages 3 and 4.