| 摘要: | 慢性腎臟病在國人的盛行率約 11.9%,慢性腎病的病患亦合併許多共病
症,近年來在慢性腎病的併發症中,慢性神經學相關的併發症如認知功能障礙
(失智症)為較常被討論的議題,失智症的主要臨床特色是記憶喪失,慢性腎臟
病產生認知功能障礙的比例大約佔 20-30%,除了透析治療佔了絕大多數的照護
資源,當慢性腎病病患產生認知功能障礙或者是記憶缺損等,會造成更大的照
顧與經濟壓力。
在學理上,三高的控制對於認知功能障礙會有幫助,而貧血的改善也對於腦
部改善氧化壓力進而延緩神經細胞退化可以有改善的效果,相關的研究目前仍
無明確的共識,本文旨在將藉由臺北醫學大學臨床研究資料庫 (TMUCRD)的資
料,了解在慢性腎病的相關併發症與失智症的相關性,以及慢性腎病的相關治
療,是否可以在延緩慢性腎病產生的同時進而減少失智症的發生。
本研究發現,在臺北醫學大學臨床研究資料庫中慢性腎病患同時有失智症個
案的比例約 4.7%,而產生失智症的風險因子為 Hb<10g/dL albumin <3.5g/dL,
calcium <8.5mg/dL, BUN>100U/L; 過高的低密度膽固醇、總膽固醇與三酸甘油
脂可做為失智症的保護因子。慢性腎病的相關治療中,紅血球生成素
(erythropoietin, EPO)以及類升糖素胜?-1 GLP-1 agonist 的使用為可能的風險因
子。經由 TrinetX 資料庫的外部驗證,發現 GLP-1 agonist 為可能的保護因子。
以北醫資料庫以及 TriNetX 的兩個資料庫的分析,可以發現人種的差異以及用
藥經驗等會影響腎病失智症產生的風險。因此在未來跨國性的世代追蹤以及相
關藥物對於腎病模型的基礎驗證等,是我們未來研究的方向。
The prevalence of chronic kidney disease (CKD) among the Taiwanese population
is approximately 11.9%. CKD patients often suffer from various comorbidities. In
recent years, chronic neurological complications, particularly cognitive impairment (dementia), have been frequently discussed among CKD complications. The primary clinical feature of dementia is memory loss, affecting around 20-30% of CKD patients. Dialysis, consuming a substantial portion of healthcare resources, exacerbates caregiving and economic burdens when CKD patients experience cognitive impairment or memory deficits.
Theoretically, controlling hypertension, hyperlipidemia, and diabetes (the "three highs") may assist in managing cognitive impairment. Improving anemia can also reduce brain oxidative stress and delay neuronal degeneration. However, consensus on these effects remains unclear in current research. This study aims to leverage data from the Taipei Medical University Clinical Research Database (TMUCRD) to explore the correlation between CKD-related complications, specifically dementia, and CKD treatments. The objective is to determine whether mitigating CKD progression could also reduce dementia incidence.
This research identifies a 4.7% prevalence of dementia among CKD patients in
the TMUCRD. Risk factors for dementia include low hemoglobin (<10g/dL), low
albumin (<3.5g/dL), low calcium (<8.5mg/dL), and high blood urea nitrogen
(>100U/L). Elevated levels of low-density lipoprotein cholesterol, total cholesterol, and triglycerides may act as protective factors against dementia. Treatment options like erythropoietin (EPO) and glucagon-like peptide-1 (GLP-1) agonists are potential risk factors within CKD management. External validation through the TriNetX database suggests GLP-1 agonists may serve as protective factors.
Analysis from both the TMUCRD and TriNetX databases highlights how factors
such as ethnicity and medication experience influence the risk of CKD-related
dementia. Future research directions include international longitudinal studies and validation of pharmacological interventions using CKD models, aiming to deepen our understanding of these relationships. |
