- 學位論文
阿斯匹靈對透析前慢性腎臟病患者的腎功能惡化之研究
Different impact of aspirin on renal progression in patients with predialysis advanced chronic kidney disease
摘要
研究目的： 末期慢性腎臟病患者使用抗血小板藥物來預防腦中風的好處以及會造成腎臟功能惡化的風險問題一直都是有爭議性。因此本研究是討論在末期慢性腎臟病患者長期使用抗血小板藥物在臨床上 (中風、心血管疾病和死亡率)的好處以及造成副作用(出血和腎衰竭)的壞處。 研究方法及資料： 我們收招了1,301位末期腎臟病病人同時接受紅血球生成素藥物治療，追踨時間從2002年1月1日到2009年7月30日止。資料來源自2005年台灣健保資料庫的百萬歸人檔。所有病人追踨時間至達到主要或次要結果(primary or secondary outcome)、或是到達研究時間的終點(2011年12月31日)。主要結果是缺血性腦中風，而次要結果是住院出血事件、心血管疾病死亡率、整體死亡率和腎衰竭發生率。本研究使用使用多變量Cox比例回歸分析計算調整的事件累積概率。 研究結果： 調整生存曲線顯示出使用阿斯匹靈無法有效降低缺血性腦中風、住院出血事件、心血管疾病死亡率和整體死亡率。反而發現慢性腎臟病病人使用阿斯匹靈會增加腎衰竭風險性。在進一步次族群分析，沒有腦中風病史的慢性腎臟病患者使用阿斯匹靈會有腎衰竭的風險(HR, 1.41; 95% CI, 1.14-1.73)。在有腦中風病史的病人中並沒有發現會造成腎功能惡化的結果(interaction p = 0.0565)。 結論與建議： 阿斯匹靈無法減少慢性腎臟病病人缺血性腦中風的發生。更重要的是，在沒有腦中風病史的慢性腎臟病患者使用阿斯匹靈可能會造成腎衰竭的風險。
並列摘要
Background: The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial. Methods: We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis. Results: Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14-1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p = 0.0565). Conclusions: There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.