A correlation between impaired bone metabolism, chronic kidney disease, and cardiovascular diseases (CVD) has been suggested. This study aimed to compare the effects of denosumab and alendronate, two anti-resorptive agents, on cardiovascular and renal outcomes in osteoporotic patients. Propensity score-matched cohort study comparing denosumab to alendronate users between January 2005 and December 2017 was conducted from a large medical organization in Taiwan. Risks of CVD development and renal function decline were estimated using Cox proportional hazard regression. A total 2523 patients were recruited in each group. No significant difference in cardiovascular events was found between the two groups over a 5-year study period. Stratified analysis results showed that denosumab was likely to exert protective effects against composite CVD in patients with medication possession rate ≥60% (adjusted hazard ratio (AHR), 0.74; p = 0.0493) and myocardial infraction (AHR, 0.42; p = 0.0415). Denosumab was associated with increased risk of renal function decline in male patients (AHR, 1.78; p = 0.0132), patients with renal insufficiency (AHR, 1.5; p = 0.0132), and patients with acute kidney injury during the study period (AHR, 1.53; p = 0.0154). Conclusively, denosumab may exert cardiovascular benefits in patients with good adherence but may have renal disadvantages in certain conditions and thus must be used with caution.
Amnioinfusion performed the first time might provide some benefits for those with early-onset oligohydramnios, such as to provide confirmation of rupture of membranes, detailed sonography examination and further counseling. We would recommend that this procedure be considered once for these cases.
Lipophilicity of statins has been linked to extrahepatic cell penetration and inhibition of isoprenoid synthesis and coenzyme Q10, which may affect myocardial contraction. Whether statins' lipophilicity affects the risk of cardiovascular disease development in patients under dialysis is unclear. This population‐based study included 114,929 patients undergoing chronic dialysis, retrieved from the Registry for Catastrophic Illness Patients from the National Health Insurance Research Database in Taiwan from 2000 to 2013. Statins were initiated after dialysis and classified into hydrophilic and lipophilic by the duration of use. In total, 17,015 statin users and match controls were identified by using propensity score matching in 1:1 ratio. New statin use was associated with higher cardiovascular disease risk (adjusted hazard ratio (aHR): 1.2, 95% confidence interval (CI), 1.13–1.28) but lower all‐cause mortality (aHR: 0.93, 95% CI, 0.89–0.96). Hydrophilic statins were significantly associated with lower risk of cardiovascular disease compared with lipophilic statins (aHR: 0.91, 95% CI, 0.85–0.97).
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