Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Rheumatology (Oxford). 2011 Dec;50(12):2278-82. doi: 10.1093/rheumatology/ker286. Epub 2011 Oct 22.
NSAIDs are commonly prescribed to control gout attacks in patients with hyperuricaemia. We investigated risk factors for NSAID-induced acute kidney injury (AKI) in patients with hyperuricaemia.
We identified 328 patients with hyperuricaemia treated with NSAIDs at Seoul National University Hospital between December 1998 and January 2008 to investigate risk factors for NSAID-induced AKI. The risk factors evaluated included age, sex, BMI, comorbidity, NSAID COX-2 selectivity, baseline glomerular filtration rate (GFR), serum uric acid, serum albumin, haemoglobin level, ratio of blood urea nitrogen and serum creatinine and the use of allopurinol. After extracting possible risk factors through univariate analysis, multivariate logistic regression analysis was performed with backward selection to derive a risk model for NSAID-induced AKI in patients with hyperuricaemia.
Thirty (9.1%) NSAID users developed AKI. Univariate analysis revealed that old age (P = 0.008), low GFR (P = 0.001), low serum albumin (P < 0.001) and low haemoglobin levels (P < 0.001) were possible risk factors. Multivariate logistic regression analysis showed that low baseline GFR [odds ratio (OR) 4.86, 95% CI 1.27, 18.55, P = 0.021, for GFR 15-29 vs ≥60 ml/min/1.73 m(2)] and low serum albumin (OR 4.43, 95% CI 1.82, 10.80, P = 0.001, for albumin ≤4 vs >4 g/dl) are risk factors for NSAID-induced AKI in patients with hyperuricaemia.
Low GFR and low serum albumin are risk factors for AKI in hyperuricaemic patients treated with NSAIDs. Our results suggest that NSAIDs should be used with caution in patients with low serum albumin.
非甾体抗炎药（NSAIDs）常用于控制高尿酸血症患者的痛风发作。我们研究了高尿酸血症患者使用 NSAIDs 后发生 NSAID 诱导的急性肾损伤（AKI）的危险因素。
我们在首尔国立大学医院于 1998 年 12 月至 2008 年 1 月期间，确定了 328 名接受 NSAIDs 治疗的高尿酸血症患者，以研究 NSAID 诱导的 AKI 的危险因素。评估的危险因素包括年龄、性别、BMI、合并症、NSAID COX-2 选择性、基线肾小球滤过率（GFR）、血尿酸、血清白蛋白、血红蛋白水平、血尿素氮与血清肌酐比值以及别嘌醇的使用。通过单因素分析提取可能的危险因素后，采用向后选择的多因素逻辑回归分析得出高尿酸血症患者 NSAID 诱导的 AKI 风险模型。
30 名（9.1%）NSAID 使用者发生 AKI。单因素分析显示，高龄（P=0.008）、低 GFR（P=0.001）、低血清白蛋白（P<0.001）和低血红蛋白水平（P<0.001）可能是危险因素。多因素逻辑回归分析显示，基线 GFR 较低[比值比（OR）4.86，95%置信区间（CI）1.2718.55，P=0.021，GFR 1529 与≥60 ml/min/1.73 m(2)）]和血清白蛋白较低（OR 4.43，95%CI 1.82~10.80，P=0.001，白蛋白≤4 与>4 g/dl）是高尿酸血症患者 NSAID 诱导的 AKI 的危险因素。
低 GFR 和低血清白蛋白是高尿酸血症患者使用 NSAIDs 后发生 AKI 的危险因素。我们的结果表明，低血清白蛋白患者应谨慎使用 NSAIDs。
