- 學位論文
腎保護性藥品用於慢性腎臟病之延緩腎功能惡化
Use renoprotective drug for chronic kidney disease to slow the progression
摘要
研究背景與目的：由於國內人口老化，腎臟相關疾病年年位居我國10 大死亡疾病之一，而透析之健保醫療支出更是高居重大傷病之首。若可以降低末期腎臟病(End Stage Renal Disease，ESRD)的發生率，即可減少龐大醫療支出，醫療資源就可以平均照顧更多重症患者。本研究可以作為治療腎功能不佳患者藥物選擇上的參考，以延遲ESRD的發生。 研究方法：本研究採用回溯性觀察研究， 取自國家衛生研究院全民健保研究資料庫承保抽樣歸人檔20萬人。研究樣本經由美國腎臟資料系統所定義為慢性腎臟病（Chronic Kidney Disease，CKD）2000年的病患，分析2001年全年用藥紀錄；追蹤2002至2004年其健康狀況變化，以卡方檢定、回歸分析統計方法，探討各因子影響情形。 研究結果：當CKD病患沒有使用腎保護劑，甚至使用腎毒性藥品時，高血壓明顯增加洗腎風險；隨年紀與其他合併症會增加其死亡機會。當CKD病患同時使用腎保護劑和腎毒性藥品，糖尿病明顯增加洗腎風險，此時腎保護劑隨使用量增加，能降低洗腎機會。鬱血性心臟病則增加死亡機會。 討論與建議：因腎保護性藥品使用與高血壓治療明顯有關係，所以當病患沒有使用腎保護劑，只有使用腎毒性藥品時，高血壓控制不好導致透析風險的提高，有高血壓合併症表現出與透析有明顯關係。當病患使用腎保護劑時，從用藥關係說明較少糖尿病患者來考慮使用此類藥品，所以只有糖尿病表現出透析風險。因資料庫限制，無法得知使用天數，使用超過181顆者明顯降低透析風險，以一般藥量使用推算至少一年內必需使用長達半年之久。
並列摘要
Research background and purpose ：As the local population ages, kidney related diseases rank as one of the top ten mortalities annually in our country, and that dialysis ranks as the number one severe disease of which medical expenditures are focused towards. If we could reduce incidence of ESRD, then huge medical budgets for ESRD could be decreased and given equally to other critically ill patients. The result of this research could serve as an reference of medication choices for patients with renal insufficiency, and further delay the occurrences of ESRD. Methods：This is a retrospective cohort study. Data of two hundred thousand people were sampled from database of National Health Insurance Registry, the National Health Research Institutes. Study samples are“CKD patients”defined by US Renal Data System in 2000 .Survey conducted on medication in the whole year of 2001 was analyzed. Changes of health situation of patients were traced from 2002 through 2004, analyzed by Chi-square test, Regression Analysis, to investigate the influence of every factor. Result ：Hypertension apparently increases the risk of dialysis as CKD patients do not use renoprotective drugs, and even use the renotoxicitive medicines. Mortality has increased due to aging and complication. As CKD patients use both renoprotective drugs and renotoxitive medicines simultaneously, diabetes obviously increases the risk of dialysis. The larger dose of a renoprotective drug is, the lower chance of dialysis they will need. In this situation, mortality has increased due to congestive heart failure. Discussion：A renoprotective drug obviously has a hypotensive effect. As patients receive renotoxicity instead of renoprotective drugs, hypertension increases the risk of dialysis. In this situation, complications from hypertension are obviously related to dialysis. As renoprotective drugs are concerned, patients with diabetes seldom use these drugs, so these patients have higher risk of dialysis. Due to the limitation of database, data about days of drug administration is unavailable. Patients who take more than 181 pills per year obviously have lower risk of dialysis.Under the general medication dosages, they should take drugs at least six months within a year.