ied to investigate the prognostic implications of medication burden regarding adverse outcomes in patients with end-stage kidney disease with maintenance hemodialysis. Methods We analyzed 26,690 patients receiving maintenance hemodialysis who participated in the Periodic Hemodialysis Quality Assessment conducted by the Health Insurance Review and Assessment Service. The exposure of interest was the number of routinely prescribed oral medications. The main outcome was a composite of non-fatal cardiovascular events (non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, or hospitalization for heart failure) or all-cause death (major adverse cardiac and cerebrovascular events). The secondary outcomes were the individual components of the primary outcome. Results During a follow-up period of 146,749 person-years (median, 6.0 years), major adverse cardiac and cerebrovascular events occurred in 17,573 (59.2%) patients. Higher medication burden was associated with progressively higher incidence of major adverse cardiac and cerebrovascular events (84.7, 107.2, 130.2, and 168.9 events per 1000 person-years in Q1–Q4, respectively). In a multivariable Cox proportional hazard model, the adjusted hazard ratios (95% confidence intervals) for the second, third, and highest quartiles were 1.05 (1.00–1.10), 1.12 (1.07–1.17), and 1.27 (1.21–1.33), respectively, compared with the lowest quartile. In continuous modeling, each increase in the number of medication was associated with a 1.03-fold (95% confidence interval 1.03–1.04) higher risk of the primary outcome. Conclusion A high medication burden was independently associated with higher risk of adverse cardiovascular outcomes and all-cause death in patients receiving maintenance hemodialysis. These findings suggest that a high medication burden could be a useful indicator of adverse clinical outcomes in patients undergoing hemodialysis. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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维持性血液透析患者的药物负担、不良心血管事件和死亡：一项全国队列研究


旨在调查药物负担对维持性血液透析的终末期肾病患者不良结局的预后影响。方法 我们对 26,690 名接受维持性血液透析的患者进行了分析，这些患者参加了健康保险审查和评估服务进行的定期血液透析质量评估。感兴趣的暴露是常规口服药物的数量。主要结局是非致命性心血管事件（非致命性心肌梗死、冠状动脉血运重建、非致命性卒中或心力衰竭住院）或全因死亡（主要不良心脑血管事件）的复合结果。次要结果是主要结果的各个组成部分。结果 在 146,749 人年（中位时间 6.0 年）的随访期间，有 17,573 名患者（59.2%）发生重大心脑血管不良事件。较高的药物负担与主要不良心脑血管事件发生率逐渐升高相关（第一季度至第四季度每 1000 人年分别为 84.7、107.2、130.2 和 168.9 起事件）。在多变量 Cox 比例风险模型中，第二、第三和最高四分位数的调整后风险比（95% 置信区间）分别为 1.05 (1.00–1.10)、1.12 (1.07–1.17) 和 1.27 (1.21–1.33)，分别与最低四分位数相比。在连续模型中，药物数量的每次增加都与主要结局风险增加 1.03 倍（95% 置信区间 1.03-1.04）相关。结论 在接受维持性血液透析的患者中，高药物负担与不良心血管结局和全因死亡风险较高独立相关。 这些发现表明，高药物负担可能是血液透析患者不良临床结果的有用指标。版权所有 © 2024 美国肾脏病学会...