多重用藥與慢性腎臟病

多重用藥通常定義為每天使用五種以上不同藥物的情況，其原因可能是多重共病症且症狀複雜，而需許多藥物控制，但若其中有一些潛在性不適當用藥或不恰當的處方，則應盡量避免使用，減少藥物不良反應與藥物交互作用。特別是慢性腎臟病患族群常患有其他的慢性疾病，例如糖尿病、高血壓、高血脂、痛風等等，造成用藥量居高不下，使其多重用藥的情形，相較於腎功能正常患者而言更為常見；此外處方的開立會因為腎功能改變而更形複雜，進一步可能導致用藥安全性問題。尤其在當今社會的老化程度持續增加，如何保護年長者的腎臟功能並避免腎臟損傷是很重要的。越來越多證據顯示，多重用藥會帶給病患諸多的負面影響：如增加急診就醫率、住院天數、甚至增加死亡率，也與腎臟功能的惡化息息相關；而潛在性不適當用藥也會加重多重用藥的問題，目前國際上有許多改善用藥的參考定義，用以提升多重用藥的認知與藥物開立的妥適性。我們認為以病人為中心的改善策略，利用最佳且客觀的證據來優化處方與減少藥物副作用，是非常必要的，藉此可以改善多重用藥與提升病患用藥安全。

關鍵字

多重用藥（Polypharmacy）；藥物不良事件（Adverse drug event）；潛在性不適當用藥（Potentially inappropriate medication）；慢性腎臟病（Chronic kidney disease）

並列摘要

Polypharmacy is usually defined as consuming more than 5 different types of drug per day. It could be due to multiple comorbidity and varied symptoms, and increased medications are required. However, if there are any potentially inappropriate medications, these drugs should be avoided to reduce adverse events and drug-drug interactions. In patients with chronic kidney disease (CKD), they are usually complicated with other chronic diseases, such as diabetes mellitus, hypertension, dyslipidemia, gout, and thus associated with large medication burden. Polypharmacy is frequently observed in CKD patients than those with normal kidney function. Moreover, prescription would be complex according to alterations of renal function, leading to drug safety issue. As the aging of our society is continuing, it is important to prevent and protect elderly from kidney dysfunction. Accumulating evidence has clearly indicated that polypharmacy is closely related to unfavorable effects, such as increase in emergency visit, hospitalization, and even death. Polypharmacy is also accompanied by deterioration of renal function. Potentially inappropriate medication (PIM) makes polypharmacy worsening, currently several international criteria are available to increase awareness and medication appropriateness. A patient-centered strategy to improve polypharmacy and patient safety is mandatory to optimize medications with best evidence and reduce adverse outcomes.

並列關鍵字

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多重用藥與慢性腎臟病

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