研究背景
末期腎臟疾病以及透析之病人，因為腎臟疾病以及其他多重併發症而同時需要多種類的藥物治療或是預防，可能增加發生藥物相關問題的風險。各種藥物相關問題中，針對透析病人使用不適當藥品以及非類固醇抗發炎藥品之處方型態分析研究，在藥物相關問題文獻中較少被單獨討論。因此，本研究目的為針對降血糖、降血脂以及其他藥品中不適合用於透析病人之藥品，以及非類固醇抗發炎類藥品等不建議用於腎功能不全患者的藥品，觀察上述研究藥品於新長期透析病患之處方型態分析。
研究方法
利用2000年至2004年全民健康保險資料庫，對象為2001年1月1日至2003年12月31日期間，年齡大於18歲(含)，長期透析之病人。觀察期間從病人開始進入長期透析日期為指標日期，觀察指標日期後一年以及前一年病人處方用藥資料，分析病人處方不適當藥品，非類固醇抗發炎藥品等主要研究藥品。
研究結果
完成納入條件以及排除條件後，2001年1月1日至2003年12月31日期間，新長期透析病人共有11,016人。
不適當藥品處方分佈，透析前處方不適當藥品有2,453人(22.3 %)，比未暴露者年齡較大(61.4歲versus 58.6歲，p< 0.0001)，男性比例較高(49.8 % versus 46.7 %，p=0.0078)，糖尿病比例較高(91.0 % versus 31.5 %，p<0.0001)，透析前30天內平均使用藥品數較多(10.3 versus 9.3，p< 0.0001)。
透析後處方不適當藥品有750人(6.8 %)，比未暴露者年齡較大(61.5歲versus 59.0歲，p< 0.0001)，男性比例較高(52.0 % versus 47.2 %，p=0.0097)，糖尿病比例較高(79.3 % versus 42.2 %，p<0.0001)，透析後30天內平均使用藥品數較多(11.9 versus 9.7，p < 0.0001)。
分析不適當藥品處方之醫事機構來源，在透析前，以區域醫院分佈比例最高(13 %)。在透析後，以地區醫院分佈比例最高(0.3%)。
透析前後，處方非類固醇抗發炎藥品分佈，透析前有7,039人(63.9 %)，透析後有6,683人(60.6 %)。不同累積劑量組別比較結果，透析前一年，高劑量組別(> 90th DDD)的病人，比非暴露組以及低劑量組別年齡較大(64.8歲versus 57.9歲 versus 59.5歲，p < 0.0001)，痛風比例較高(41.1 % versus 8.8 % versus 18.0 %，p < 0.0001)，性別以及糖尿病比例在三組沒有差異。透析後一年，高劑量組別(> 90th DDD)的病人，比非暴露組以及低劑量組別年齡較大(64.5歲versus 58.0歲 versus 59.5歲，p < 0.0001)，女性比例較高(54.7 % versus 50.4 % versus 53.8 %，p=0.0015)，痛風比例較高(29.1 % versus 11.7 % versus 17.5 %，p < 0.0001)，糖尿病則在低劑量組有較高比例 (p=0.0324)。
分析非類固醇抗發炎藥品處方之醫事機構來源，透析前，以區域醫院分佈比例最高 (10.9 %)。透析後，以基層診所分佈比例最高(4.30 %)。
研究結論
長期透析族群可能會有多重用藥、被處方不適當藥品以及非類固醇抗發炎藥品等藥物相關問題。使用藥品數較多、年齡較大、男性病人、糖尿病、地區醫院以及醫學中心處方等，處方較多比例之不適當藥品。另外，年齡較大、女性、痛風病人 、基層診所以及地區醫院處方等，處方較多比例之非類固醇抗發炎藥品。

Background
Pre-end stage renal disease (ESRD) patients and dialysis patients have multiple complications that require multiple medications to control the disease, which may further increase the risk of drug related problems. It has been proven in the literature that kidney disease in dialysis pateints、number of comorbidity、number of medication use and diabetes are risk factors for drug related problems. Nevertheless, among the various drug related problems in pre-ESRD and dialysis patients, the prescription patterns of inappropriate drugs (contraindication drugs) and the controversial medication (Non-Steroidal Anti-Inflammatory Drugs) have been rarely reported in the literature. Thus, the study objectives were to observe and analyze the prescription patterns including the inappropriate drugs such as hypoglycemic agents, hypolipidemic agents and NSAIDs, which might be used in dialysis patients.
Methods
We included new chronic dialysis patients who were identified from 1 Jan 2003 through 31 Dec 2003 and older than 18 years old by using National Health Insurance claims database. We obsevered one year period before and after the index date which was the date of the first dialysis recorded. The prescription patterns of inappropriate drugs and Non-Steroidal Anti-Inflammatory Drugs were analyzed according to demographic characteristics, number of drugs, comorbidities and health care settings.
Results
We identified 11,016 newly chronic dialysis patients after inclusion and exclusion criteria.
There were 750 pateints (6.8 %) being prescribed inappropriate drug after dialysis and 2,453 patients (22.3 %) before dialysis. Comparing with the non-exposure group before dialysis, patients exposed to inappropriate drugs were older (61.4 years versus 58.6 years, p <0.0001), higher proportions in male (49.8% versus 46.7%, p = 0.0078) and more diabetics (91.0% versus 31.5%, p <0.0001), and received more medications within a month before starting dialysis (10.3 versus 9.3，p< 0.0001). In addition, comparing with the non-exposure group after dialysis, patients exposed to inappropriate drugs were older (61.5 years versus 59.0 years, p <0.0001), higher proportions in male (52.0% versus 47.2%, p = 0.0097) and more diabetics (79.3% versus 42.2%, p <0.0001), and received more medications within a month after dialysis (11.9 versus 9.7，p < 0.0001).
There were 7,039 patients (63.9 %) being prescribed NSAIDs before dialysis, and 6,683 patients (60.6 %) after dialysis. Patents were classified into three groups according to one year cumulative dose of NSAIDs. Before dialysis, the patients in the group with high dose (> 90th DDD) were older than the non-exposure group and the low does group (64.8 years versus 57.9 years versus 59.5 years, p <0.0001), and have higher proportion of gout (41.1 % versus 8.8 % versus 18.0 %，p < 0.0001); Gender and diabetics have no differences in these three groups.
After dialysis, the patients in the group with high dose (> 90th DDD) were older than the non-exposure group and the low dose group (64.5 years versus 58.0 years versus 59.5 years, p <0.0001), and have higher proportions in females (54.7 % versus 50.4 % versus 53.8 %，p=0.0015), additionally, the proportion of gout is the highest in the high dose group (29.1 % versus 11.7 % versus 17.5 %，p < 0.0001); Diabetic proportion is the highest in the low dose group (p=0.0324).
Conclusion
Long-term dialysis population may have multiple drugs, being prescribed inappropriate drugs as well as non-steroidal anti-inflammatory drugs and other drug-related problems. Patients who were older, male, diabetes, received more medicaitions, and prescription from regional hospitals and medical centers, prescribed higher proportion of inappropriate medications. Patients who were older, female, gout patients, and prescription from primary care clinics and district hospitals, prescribed higher proportion of non-steroidal anti-inflammatory drugs.

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