Institute of Nephrology and Division of Nephrology, Peking University First Hospital No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China.
Nephrol Dial Transplant. 2011 Jun;26(6):1916-23. doi: 10.1093/ndt/gfq679. Epub 2010 Nov 8.
Prescription drug abuse is an important global health concern. Our previous survey in Beijing indicates that nephrotoxic medication use is independently associated with chronic kidney disease (CKD).
In the present study, the study population consisted of participants from our previous survey with a confirmed history of nephrotoxic medication use. Nephrotoxic mediations included three antipyretic analgesics (58.2%) and three Chinese traditional medicines containing aristolochic acids (CTM-AAs, 47.3%). Prevalence of CKD (defined by presence of albuminuria and/or reduced estimated glomerular filtration rate) as well as markers of tubular injury was analysed, and compared with 109 age- and sex-matched controls.
The prevalence of CKD was higher among medication users compared with controls, which was 18.3% and 8.5%, respectively. Among participants with medication use without CKD, markers of tubular injury including N-acetyl-β-d-glucosaminidase, transferrin and α(1)-microglobulin, were present in 26.6%. CKD was associated with CTM-AA use (cumulative AA-I dose > 0.5 g, OR = 5.625, P < 0.05) and antipyretic analgesic use (cumulative dose > 2.0 kg, OR = 3.848, P = 0.063) in a dose-dependent manner. Albuminuria and tubular injury persisted among CTM-AA users, but not among analgesic users after cessation of drug.
Our study suggests that education about rational analgesic use and CTM-AA banning may constitute an effective CKD prevention strategy.
处方药物滥用是一个重要的全球性健康问题。我们之前在北京进行的调查表明，肾毒性药物的使用与慢性肾脏病（CKD）独立相关。
在本研究中，研究人群由我们之前调查中使用过肾毒性药物且有明确病史的参与者组成。肾毒性药物包括三种解热镇痛药（58.2%）和三种含马兜铃酸的中药（CTM-AA，47.3%）。分析了 CKD（通过蛋白尿和/或估算肾小球滤过率降低来定义）以及肾小管损伤标志物的患病率，并与 109 名年龄和性别匹配的对照者进行了比较。
与对照组相比，药物使用者的 CKD 患病率更高，分别为 18.3%和 8.5%。在无 CKD 的药物使用者中，存在肾小管损伤标志物，包括 N-乙酰-β-D-氨基葡萄糖苷酶、转铁蛋白和α(1)-微球蛋白，占 26.6%。CKD 与 CTM-AA 的使用相关（累积 AA-I 剂量>0.5g，OR=5.625，P<0.05）和解热镇痛药的使用（累积剂量>2.0kg，OR=3.848，P=0.063）呈剂量依赖性。在停止使用药物后，CTM-AA 使用者的蛋白尿和肾小管损伤仍然存在，但在镇痛剂使用者中不存在。
我们的研究表明，关于合理使用镇痛药和禁止使用 CTM-AA 的教育可能构成有效的 CKD 预防策略。
