Kaewput Wisit, Disorn Preedee, Satirapoj Bancha
Department of Military and Community Medicine, Phramongkutklao College of Medicine; Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Int J Nephrol Renovasc Dis. 2016 Nov 7;9:273-278. doi: 10.2147/IJNRD.S121698. eCollection 2016.
The use of selective COX-2 (sCOX-2) inhibitors with acute kidney injury, salt water retention, and cardiovascular events have been correlated in subjects with normal kidney function, but sCOX-2 inhibitor use concerning the progression of chronic kidney disease (CKD) remains uncertain.
To determine the progression of renal function and electrolyte abnormalities among CKD patients after using sCOX-2 inhibitors during short- and long-term periods.
The study employed a retrospective cohort design comprising all types of CKD patients with and without sCOX-2 inhibitors (celecoxib and etoricoxib). Data collected included medical data, estimated glomerular filtration rate (eGFR), and serum electrolytes at 3 and 6 months between January 2009 and January 2014. Subjects attended the outpatient clinic and were then followed up until discontinuation of the drugs at years 1 and 2 until May 2016.
Ninety-two CKD patients on sCOX-2 inhibitors and 92 CKD patients without sCOX-2 inhibitors were included. The sCOX-2 inhibitor group showed more decline in eGFR than the control group at 3 and 6 months of follow-up (-8.27±9.75 vs -1.64±6.05 mL/min/1.73 m, <0.001 and -12.36±6.48 vs -4.31±5.11 mL/min/1.73 m, =0.001, respectively) and at 1 and 2 years of follow-up after subjects discontinued sCOX-2 (-6.84±10.34 vs -1.61±8.93 mL/min/1.73 m, =0.004 and -10.26±10.19 vs -5.12±8.61 mL/min/1.73 m, =0.005, respectively). In addition, the sCOX-2 inhibitor group had significantly more increased serum potassium during the study follow-up than the control group.
The sCOX-2 inhibitors are associated with an increased risk for rapid eGFR decline and hyperkalemia in both the short term and in the long term after sCOX-2 inhibitors were terminated in the setting of a community-based CKD population. For CKD patients, these results suggest that sCOX-2 inhibitors should be closely monitored and chronic exposure to any sCOX-2 inhibitors should be avoided.
在肾功能正常的受试者中，选择性环氧化酶-2（sCOX-2）抑制剂的使用与急性肾损伤、水钠潴留及心血管事件相关，但sCOX-2抑制剂的使用与慢性肾脏病（CKD）进展的关系仍不明确。
确定短期和长期使用sCOX-2抑制剂后CKD患者的肾功能进展及电解质异常情况。
本研究采用回顾性队列设计，纳入所有使用和未使用sCOX-2抑制剂（塞来昔布和依托考昔）的各类CKD患者。收集2009年1月至2014年1月期间3个月和6个月时的医疗数据、估计肾小球滤过率（eGFR）及血清电解质。受试者前往门诊就诊，随后随访至1年和2年停药时，直至2016年5月。
纳入92例使用sCOX-2抑制剂的CKD患者和92例未使用sCOX-2抑制剂的CKD患者。在随访的3个月和6个月时，sCOX-2抑制剂组的eGFR下降幅度大于对照组（分别为-8.27±9.75 vs -1.64±6.05 mL/min/1.73 m²，P<0.001；-12.36±6.48 vs -4.31±5.11 mL/min/1.73 m²，P=0.001），在受试者停用sCOX-2抑制剂后的1年和2年随访时也是如此（分别为-6.84±10.34 vs -1.61±8.93 mL/min/1.73 m²，P=0.004；-10.26±10.19 vs -5.12±8.61 mL/min/1.73 m²，P=0.005）。此外，在研究随访期间，sCOX-2抑制剂组的血清钾升高明显多于对照组。
在社区CKD人群中，sCOX-2抑制剂停用后，短期和长期均与eGFR快速下降及高钾血症风险增加相关。对于CKD患者，这些结果提示应密切监测sCOX-2抑制剂，避免长期使用任何sCOX-2抑制剂。
