使用SGLT2抑制剂的慢性肾病患者的肾毒性药物负担和药物相关问题
Nephrotoxic medication burden and drug-related problems in patients with chronic kidney disease using SGLT2 inhibitors.
摘要(中文译文)
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）因其肾脏和心血管获益而日益被广泛处方。然而，慢性肾脏病（CKD）患者中多重用药现象普遍，引发了对累积性肾毒性药物暴露的担忧。本研究旨在评估肾脏内科门诊中接受SGLT2i治疗患者的药物相关问题（DRPs）、肾毒性药物负担、肾衰竭风险及患者报告结局。本观察性研究于2022年9月至2023年2月在一所大学医院的肾脏内科门诊进行。纳入新处方SGLT2抑制剂且年龄≥18岁的患者。由临床药师进行全面的用药审查，采用欧洲药学监护网络（PCNE）分类系统识别并归类DRPs，并基于药物特异性风险分级采用结构化肾毒性评分评估肾毒性暴露。使用肾衰竭风险方程估算肾衰竭风险，并使用KDQOL-36问卷评估生活质量。共纳入72例患者，通过临床药师主导的用药审查识别出69项DRPs。最常见的DRPs为用药疗程不适当（20.3%）、无适应证用药（15.9%）和未治疗的症状（13.0%）。药师的建议接受率较高（85.5%）。每位患者肾毒性药物数量的中位数为2种（IQR：1-3），肾毒性评分中位数为1.5（IQR：1-2）。随访期间未观察到临床明显的肾毒性事件，肾毒性负担与估算肾衰竭风险无显著关联。本研究提供了肾脏内科门诊环境中接受SGLT2i治疗的CKD患者肾毒性药物暴露、药物相关问题及临床药师主导用药审查的真实世界描述性数据。需要进一步的前瞻性对照研究以阐明药师主导的用药审查对患者的临床影响。
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly prescribed because of their renal and cardiovascular benefits. However, polypharmacy is common among patients with chronic kidney disease (CKD), raising concerns about cumulative nephrotoxic medication exposure. This study aimed to evaluate drug-related problems (DRPs), nephrotoxic medication burden, kidney failure risk, and patient-reported outcomes in patients receiving SGLT2i in a nephrology outpatient clinic. This observational study was conducted in a nephrology outpatient clinic of a university hospital between September 2022-February 2023. Patients ≥18 years who were newly prescribed an SGLT2 inhibitor were included. A clinical pharmacist performed comprehensive medication reviews, identified and categorized DRPs using the Pharmaceutical Care Network Europe (PCNE) classification system, and assessed nephrotoxic exposure by a structured nephrotoxicity score based on drug-specific risk categories. Kidney failure risk was estimated using the Kidney Failure Risk Equation, and quality of life was assessed using the KDQOL-36 questionnaire. Seventy-two patients were included, and 69 DRPs were identified through clinical pharmacist-led medication review. The most common DRPs were inappropriate duration of therapy (20.3%), medication without indication (15.9%), and untreated symptoms (13.0%). Pharmacist's recommendations were highly accepted (85.5%). The median number of nephrotoxic drugs per patient was 2 (IQR:1-3), while the median nephrotoxicity score was 1.5 (IQR: 1-2). No clinically overt nephrotoxic events were observed during follow-up, and nephrotoxicity burden was not significantly associated with estimated kidney failure risk. This study provides real-world descriptive data on nephrotoxic medication exposure, drug-related problems, and clinical pharmacist-led medication review among CKD patients receiving SGLT2i in a nephrology outpatient setting. Further prospective controlled studies are needed to clarify the clinical impact of pharmacist-led medication review on patient.
如何引用
AMA
Zeynep Ozturk Yalcin, Arda Erdut, Guldehan Haberal, Mustafa Arici, Aygin Bayraktar-Ekincioglu. Nephrotoxic medication burden and drug-related problems in patients with chronic kidney disease using SGLT2 inhibitors.. Renal failure. 2026; doi:10.1080/0886022X.2026.2688512.
APA
Zeynep Ozturk Yalcin, Arda Erdut, Guldehan Haberal, Mustafa Arici, Aygin Bayraktar-Ekincioglu (2026). Nephrotoxic medication burden and drug-related problems in patients with chronic kidney disease using SGLT2 inhibitors.. Renal failure. https://doi.org/10.1080/0886022X.2026.2688512
GB/T 7714
Zeynep Ozturk Yalcin, Arda Erdut, Guldehan Haberal, Mustafa Arici, Aygin Bayraktar-Ekincioglu. Nephrotoxic medication burden and drug-related problems in patients with chronic kidney disease using SGLT2 inhibitors.[J]. Renal failure, 2026 doi:10.1080/0886022X.2026.2688512.
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