Bonnecaze Alex K, Wilson Matthew W, Dharod Ajay, Fletcher Alison, Miller Peter John
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Internal Medicine, Section on General Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Nephrology (Carlton). 2018 Oct;23(10):921-926. doi: 10.1111/nep.13153.
Prescription opioid abuse poses a serious problem in the United States, representing 615 per 100 000 deaths annually. Extended-release oxymorphone (Opana-ER) is an oral opioid pain medication that has recently been found to cause thrombotic microangiopathy when intravenously abused. In this retrospective study, we attempted to determine the prevalence and outcomes of acute kidney injury (AKI) among patients intravenously abusing extended-release oral oxymorphone.
A query of electronic medical records for 'drug abuse' at an academic medical centre during January 2012 to December 2015 was performed and yielded 2350 patients. Patients were further identified by documented intravenous abuse of extended-release oxymorphone. Patients were stratified based on multiple renal indices and outcomes. Potential confounders were also identified.
One hundred and sixty-five patients were found to have a documented history of intravenous abuse of extended-release oral oxymorphone. Prevalence of AKI in this population was a 47.8%. KDIGO stage-I patients consisted of 17.8% of patients with AKI, 40.5% were classified as KDIGO stage-II AKI, and 41.8% were classified as KDIGO stage-III AKI. Among patients with AKI, average age was found to be 37.5 years, 59.4% experienced renal recovery, 56.9% required intensive care unit admission, 13.9% progressed to end-stage renal disease (ESRD), and 7.6% expired during admission.
Clinicians should be educated to help recognize intravenous abuse of extended-release oral oxymorphone and its associated effects. Our data suggests AKI is common in these patients; higher KDIGO staging appears to be associated with slower rates of renal recovery, increased comorbidities and progression to both CKD and ESRD.
处方阿片类药物滥用在美国是一个严重问题，每年每10万人中有615人死亡。缓释羟吗啡酮（奥施康定缓释片）是一种口服阿片类镇痛药，最近发现静脉滥用时会导致血栓性微血管病。在这项回顾性研究中，我们试图确定静脉滥用缓释口服羟吗啡酮患者中急性肾损伤（AKI）的患病率及转归情况。
对某学术医疗中心2012年1月至2015年12月期间电子病历中“药物滥用”进行查询，共获得2350例患者。通过记录静脉滥用缓释羟吗啡酮进一步确定患者。根据多种肾脏指标和转归对患者进行分层。同时确定潜在混杂因素。
发现165例患者有静脉滥用缓释口服羟吗啡酮的记录史。该人群中AKI的患病率为47.8%。KDIGO 1期患者占AKI患者的17.8%，40.5%被分类为KDIGO 2期AKI，41.8%被分类为KDIGO 3期AKI。在AKI患者中，平均年龄为37.5岁，59.4%的患者肾功能恢复，56.9%的患者需要入住重症监护病房，13.9%进展为终末期肾病（ESRD），7.6%在住院期间死亡。
应教育临床医生识别静脉滥用缓释口服羟吗啡酮及其相关影响。我们的数据表明AKI在这些患者中很常见；较高的KDIGO分期似乎与肾功能恢复较慢、合并症增加以及进展为慢性肾脏病和ESRD有关。
