非典型抗精神病药物与老年人急性肾损伤和其他不良结局的风险：一项基于人群的队列研究。

Atypical antipsychotic drugs and the risk for acute kidney injury and other adverse outcomes in older adults: a population-based cohort study.

出版信息

Ann Intern Med. 2014 Aug 19;161(4):242-8. doi: 10.7326/M13-2796.

Abstract

BACKGROUND

Several adverse outcomes attributed to atypical antipsychotic drugs, specifically quetiapine, risperidone, and olanzapine, are known to cause acute kidney injury (AKI). Such outcomes include hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis.

OBJECTIVE

To investigate the risk for AKI and other adverse outcomes associated with use of atypical antipsychotic drugs versus nonuse.

DESIGN

Population-based cohort study.

SETTING

Ontario, Canada, from 2003 to 2012.

PATIENTS

Adults aged 65 years or older who received a new outpatient prescription for an oral atypical antipsychotic drug (n=97,777) matched 1:1 with those who did not receive such a prescription.

MEASUREMENTS

The primary outcome was hospitalization with AKI (assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels) within 90 days of prescription for atypical antipsychotic drugs.

RESULTS

Atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI (relative risk [RR], 1.73 [95% CI, 1.55 to 1.92]). This association was consistent when AKI was assessed in a subpopulation for which information on serum creatinine levels was available (5.46% vs. 3.34%; RR, 1.70 [CI, 1.22 to 2.38]; absolute risk increase, 2.12% [CI, 0.80% to 3.43%]). Drug use was also associated with hypotension (RR, 1.91 [CI, 1.60 to 2.28]), acute urinary retention (RR, 1.98 [CI, 1.63 to 2.40]), and all-cause mortality (RR, 2.39 [CI, 2.28 to 2.50]).

LIMITATION

Only older adults were included in the study.

CONCLUSION

Atypical antipsychotic drug use is associated with an increased risk for AKI and other adverse outcomes that may explain the observed association with AKI. The findings support current safety concerns about the use of these drugs in older adults.

PRIMARY FUNDING SOURCE

Academic Medical Organization of Southwestern Ontario.

摘要

背景

几种归因于非典型抗精神病药物的不良后果，特别是喹硫平、利培酮和奥氮平，已知会导致急性肾损伤（AKI）。这些后果包括低血压、急性尿潴留和神经阻滞剂恶性综合征或横纹肌溶解症。

目的

研究使用非典型抗精神病药物与不使用相比与 AKI 和其他不良后果相关的风险。

设计

基于人群的队列研究。

地点

加拿大安大略省，2003 年至 2012 年。

患者

接受新的门诊口服非典型抗精神病药物处方的年龄在 65 岁或以上的成年人（n=97777）与未接受此类处方的成年人 1:1 匹配。

测量

主要结局是在处方非典型抗精神病药物后 90 天内因 AKI 住院（通过医院诊断代码评估，在亚人群中通过血清肌酐水平评估）。

结果

与不使用非典型抗精神病药物相比，使用非典型抗精神病药物与 AKI 住院风险增加相关（相对风险 [RR]，1.73 [95%CI，1.55 至 1.92]）。当对可获得血清肌酐水平信息的亚人群进行 AKI 评估时，这种关联是一致的（5.46%比 3.34%；RR，1.70 [CI，1.22 至 2.38]；绝对风险增加，2.12% [CI，0.80% 至 3.43%]）。药物使用还与低血压（RR，1.91 [CI，1.60 至 2.28]）、急性尿潴留（RR，1.98 [CI，1.63 至 2.40]）和全因死亡率（RR，2.39 [CI，2.28 至 2.50]）相关。