Sandler D P, Burr F R, Weinberg C R
National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
Ann Intern Med. 1991 Aug 1;115(3):165-72. doi: 10.7326/0003-4819-115-3-165.
To evaluate the risk for chronic renal disease associated with regular use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs).
Multicenter case-control study.
Patients were 554 North Carolina residents (age range, 30 to 79 years) hospitalized between 1980 and 1982 with a discharge diagnosis indicating newly diagnosed chronic renal dysfunction and a serum creatinine level consistently at or above 130 mumol/L (1.5 mg/dL). Controls were 516 persons chosen randomly by telephone screening (if younger than 65 years of age) and from listings of Medicare recipients (if 65 years of age or older), frequency-matched to patients by age, race, sex, and proximity to study hospitals.
Data on use of prescription NSAIDs and other analgesics before 1980, other risk factors, and potential confounders were obtained by telephone interviews. Patients were classified by frequency and duration of use; daily users were those who took an NSAID for at least 360 consecutive days.
A twofold risk for chronic renal disease was associated with previous daily use of NSAIDs (adjusted odds ratio, 2.1; 95% Cl, 1.1 to 4.1). Increased risk was predominantly limited to men older than 65 years, for whom the odds ratio for daily use was 10.0 (Cl, 1.2 to 82.7) after adjusting for use of other analgesics. In other age-sex groups, the risk associated with NSAID use tended to be increased among those with heart disease or other factors that might indicate compromised renal circulation. These findings did not result from confounding by known renal disease risk factors and were not readily explained by potential biases.
Regular use of NSAIDs may increase the risk for chronic kidney disease in some high-risk groups. With the recent over-the-counter availability and increasing popularity of NSAIDs, the possibility of an increased risk for chronic renal disease associated with their use may warrant further scrutiny.
评估长期使用非阿司匹林类非甾体抗炎药（NSAIDs）与慢性肾病风险之间的关联。
多中心病例对照研究。
554名北卡罗来纳州居民（年龄范围30至79岁），于1980年至1982年间住院，出院诊断显示为新诊断的慢性肾功能不全，且血清肌酐水平持续处于或高于130μmol/L（1.5mg/dL）。对照组为516人，通过电话筛查（年龄小于65岁者）以及医疗保险受益人名单（年龄65岁及以上者）随机选取，在年龄、种族、性别以及与研究医院的距离方面与患者进行频数匹配。
通过电话访谈获取1980年前使用处方NSAIDs及其他镇痛药的数据、其他风险因素以及潜在混杂因素。患者按使用频率和时长进行分类；每日使用者为连续至少360天服用NSAIDs者。
既往每日使用NSAIDs与慢性肾病风险增加两倍相关（校正比值比为2.1；95%可信区间为1.1至4.1）。风险增加主要局限于65岁以上男性，校正其他镇痛药使用情况后，其每日使用的比值比为10.0（可信区间为1.2至82.7）。在其他年龄 - 性别组中，NSAIDs使用相关风险在患有心脏病或其他可能提示肾循环受损因素的人群中往往增加。这些发现并非由已知的肾病风险因素混杂所致，也难以用潜在偏倚来解释。
长期使用NSAIDs可能会增加某些高危人群患慢性肾病的风险。鉴于近期NSAIDs可非处方购买且越来越受欢迎，其使用与慢性肾病风险增加的可能性值得进一步审视。
