慢性肾脏病患者停用钠-葡萄糖转运体-2 抑制剂和胰高血糖素样肽-1 受体激动剂。

IF 10.3 1区医学 Q1 UROLOGY & NEPHROLOGY Journal of The American Society of Nephrology Pub Date : 2025-01-01 Epub Date: 2024-08-26 DOI:10.1681/ASN.0000000000000477

L Parker Gregg, Peter A Richardson, Vijay Nambi, Laura A Petersen, Michael E Matheny, Salim S Virani, Sankar D Navaneethan

引用次数: 0

摘要

背景：关于停用钠-葡萄糖协同转运体-2（SGLT2）抑制剂和胰高血糖素样肽-1受体激动剂（GLP-1 RA）与慢性肾脏病（CKD）患者预后的关系知之甚少：我们对退伍军人事务部医疗系统中 2005-2022 年间患有 CKD 3-4 期的成年人进行了鉴定。我们纳入了开具 SGLT2 抑制剂或 GLP-1 RAs 处方的患者，并将首次配药日期视为指标日期。使用 Cox 比例危险度回归模型研究了与首次中断治疗时间（定义为 SGLT2 抑制剂或 GLP-1 RA 处方中断时间≥90 天）相关的因素。使用 Cox 比例危险度回归评估了停药 90-179 天和≥180 天与死亡、心肌梗死、冠状动脉血运重建、心力衰竭住院和缺血性中风的关系：在96,345名接受SGLT2抑制剂治疗的患者和60,020名接受GLP-1 RA治疗的患者中，35,953名SGLT2抑制剂使用者（37%）和28,407名GLP-1 RA使用者（47%）至少有一次停药。SGLT2 抑制剂使用者中 24% 为黑人，71% 为白人，71% 年龄≥70 岁，84% 为 CKD 3a 期。GLP-1 RA 使用者中 20% 为黑人，75% 为白人，63% 年龄≥70 岁，81% 为 CKD 3a 期。黑人、西班牙裔、脑血管疾病、外周血管疾病和缺血性心脏病与停用这两类药物有关。女性和更晚期的慢性肾功能衰竭分期也与 SGLT2 抑制剂的停用有关。停用 SGLT2 抑制剂≥180 天与死亡（调整后危险比 [HR] 1.67，95% 置信区间 [CI] 1.58-1.77）和心衰住院（调整后 HR 1.26，95% CI 1.13-1.40）有关。停用 GLP-1 RA≥180 天与死亡（调整后 HR 1.97，95% CI 1.87-2.07）、心肌梗死（调整后 HR 1.23，95% CI 1.11-1.36）、心衰住院（调整后 HR 1.48，95% CI 1.33-1.64）和缺血性中风（调整后 HR 1.24，95% CI 1.14-1.35）有关：结论：SGLT2 抑制剂和 GLP-1 RA 的停药在慢性肾脏病成人患者中很常见，并与有害结果相关。

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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.

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