Choi Nam-Kyong, Lee Joongyub, Chang Yoosoo, Kim Ye-Jee, Kim Ju-Young, Song Hong Ji, Shin Ju-Young, Jung Sun-Young, Choi Yukyong, Lee Jin-Ho, Park Byung-Joo
Medical Research Collaborating Center, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea.
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Endoscopy. 2014 Jun;46(6):465-70. doi: 10.1055/s-0034-1365419. Epub 2014 Apr 25.
Oral sodium phosphate (OSP) is a cleansing agent for colonoscopy. Recent reports have cited an increased risk of acute renal failure (ARF) in OSP bowel purgative users, but this risk remains under debate. This study was performed to evaluate the association between OSP and ARF in patients who underwent colonoscopy.
A population-based case-crossover study was conducted using the Korean Health Insurance Review and Assessment Service (HIRA) claims data from 1 January 2005 to 31 December 2009. The study population consisted of patients aged ≥ 50 years who underwent colonoscopies after an OSP prescription prior to their first hospitalization for ARF. For each patient, one hazard and four control periods were matched at specified time windows. Conditional logistic regression analysis was used to estimate the odds ratio (OR) and 95 % confidence interval (CI), adjusting for concomitant medications that could induce ARF.
A total of 1105 patients were included (54 % male). The adjusted ORs for ARF related to the use of OSP when applying the 1-, 2-, 4-, 8-, or 12-week time windows were 3.7 (95 %CI 2.37 - 5.67), 3.5 (95 %CI 2.45 - 4.89), 3.0 (95 %CI 2.30 - 3.95), 2.4 (95 %CI 1.93 - 2.96), and 2.0 (95 %CI 1.69 - 2.46), respectively. When adopting an 8-week time window, the adjusted OR was 2.5 (95 %CI 1.98 - 3.16) for the subgroup without chronic renal failure.
The use of OSP was significantly associated with ARF both in patients with and without co-morbidities.
口服磷酸钠（OSP）是一种用于结肠镜检查的清洁剂。近期报告指出，使用OSP进行肠道准备的患者急性肾衰竭（ARF）风险增加，但这一风险仍存在争议。本研究旨在评估接受结肠镜检查的患者中OSP与ARF之间的关联。
利用韩国健康保险审查与评估服务机构（HIRA）2005年1月1日至2009年12月31日的理赔数据进行了一项基于人群的病例交叉研究。研究人群包括年龄≥50岁、在首次因ARF住院前接受过OSP处方后进行结肠镜检查的患者。对于每位患者，在特定时间窗口匹配一个风险期和四个对照期。采用条件逻辑回归分析来估计比值比（OR）和95%置信区间（CI），并对可能诱发ARF的合并用药进行校正。
共纳入1105例患者（54%为男性）。在应用1周、2周、4周、8周或12周时间窗口时，与使用OSP相关的ARF校正OR分别为3.7（95%CI 2.37 - 5.67）、3.5（95%CI 2.45 - 4.89）、3.0（95%CI 2.30 - 3.95）、2.4（95%CI 1.93 - 2.96）和2.0（95%CI 1.69 - 2.46）。采用8周时间窗口时，无慢性肾衰竭亚组的校正OR为2.5（95%CI 1.98 - 3.16）。
无论有无合并症，使用OSP均与ARF显著相关。
