Medication utilization.

Proteinuria is a major side-effect of the anti-tumor drug bevacizumab, although its incidence and risk factors in the real world are still unclear. Although renin-angiotensin-aldosterone system inhibitors are used clinically to prevent proteinuria, their efficacy remains unclear. The aim of the present study was to reveal the incidence and risk factors of bevacizumab-induced proteinuria and examine the effectiveness of antihypertensive drugs in preventing proteinuria. We conducted a retrospective cohort study using the National Hospital Organization Clinical Data Archives and Medical Information Analysis Databank. Hospitalized patients who received bevacizumab between January 1, 2016, and June 30, 2019, were included. The study outcome was proteinuria within 12 months of bevacizumab administration. Patient characteristics, laboratory tests, and medications were compared between patients with and without proteinuria using multivariable logistic regression analysis. Among the 2,458 patients, 27% developed proteinuria after bevacizumab administration. Nursing dependence (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.89–3.05; P2 had 29.7%, 76.8%, and 66.0% higher odds of proteinuria, respectively, than those with an eGFR ≥90 mL/min/1.73 m2. No significant relationship was observed between antihypertensive drugs and the occurrence of proteinuria. More patients may suffer from proteinuria after bevacizumab administration than previously reported. Nursing dependence and systolic blood pressure are predictive risk factors for bevacizumab-induced proteinuria. Patients at risk of proteinuria should be closely monitored.

蛋白尿（proteinuria）是抗肿瘤药物贝伐珠单抗（bevacizumab）的主要不良反应，但真实世界中其发生率与危险因素仍未明确。尽管临床中常使用肾素-血管紧张素-醛固酮系统抑制剂（renin-angiotensin-aldosterone system inhibitors）预防蛋白尿，但其疗效仍不明确。本研究旨在明确贝伐珠单抗相关性蛋白尿的发生率与危险因素，并评估降压药物预防蛋白尿的有效性。本研究基于全国医院组织临床数据档案库与医学信息分析数据库开展回顾性队列研究，纳入2016年1月1日至2019年6月30日期间接受贝伐珠单抗治疗的住院患者。本研究的主要结局为贝伐珠单抗给药后12个月内出现蛋白尿。采用多变量logistic回归分析，对比存在蛋白尿与未出现蛋白尿患者的临床特征、实验室检查结果及用药情况。在2458例患者中，27%的患者在接受贝伐珠单抗治疗后出现蛋白尿。护理依赖状态患者发生蛋白尿的比值比（odds ratio [OR]）为2.40，95%置信区间（confidence interval [CI]）为1.89~3.05（原文P值疑似存在笔误）；与估算肾小球滤过率（eGFR）≥90 mL/min/1.73m²的患者相比，eGFR分别处于<30、30~59及60~89 mL/min/1.73m²分层的患者，其发生蛋白尿的风险分别升高29.7%、76.8%与66.0%。未观察到降压药物与蛋白尿的发生存在显著相关性。本研究结果提示，贝伐珠单抗治疗后发生蛋白尿的患者比例可能高于既往报道；护理依赖状态与收缩压是贝伐珠单抗相关性蛋白尿的预测危险因素，对于存在蛋白尿风险的患者应予以密切监测。