Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University Medical School, Newcastle University, Newcastle upon Tyne, UK.
Department of Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Int J Infect Dis. 2018 Sep;74:97-99. doi: 10.1016/j.ijid.2018.07.002. Epub 2018 Jul 7.
This study sought to identify the incidence of, and risk factors for, acute kidney injury (AKI) in adults treated with parenteral aciclovir.
A single-centre retrospective cohort study of prospectively acquired electronic clinical, pharmacy and laboratory data was performed with approval of the Caldicott guardian. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria, prior to analysis of baseline patient and treatment-related risk factors.
269 aciclovir treatment episodes were identified in 268 patients. Overall incidence of AKI was 13%. Half of AKI episodes were KDIGO grade 2/3. In univariate analysis, AKI occurred more frequently in patients with pre-existing chronic kidney disease (CKD), diabetes, and in patients treated with higher daily doses of aciclovir. There was also a trend to increased age in patients with AKI. In a binomial logistic regression model only CKD and daily dose remained significant independent factors.
AKI is an important side effect of parenteral aciclovir, the incidence of which is comparable to established nephrotoxic drugs such as aminoglycosides. Patients with pre-existing chronic kidney disease or receiving higher total doses are at greatest risk, reinforcing the clinical importance of appropriate dose adjustment for ideal body weight and baseline renal function.
本研究旨在确定接受静脉用阿昔洛韦治疗的成年人发生急性肾损伤（AKI）的发生率和相关危险因素。
本研究为单中心回顾性队列研究，使用前瞻性获取的电子临床、药学和实验室数据，并获得了 Caldicott 监护人的批准。在分析基线患者和治疗相关危险因素之前，根据改善全球肾脏病预后组织（KDIGO）标准定义 AKI。
在 268 例患者中确定了 269 例阿昔洛韦治疗发作。AKI 的总体发生率为 13%。半数 AKI 发作属于 KDIGO 分级 2/3。在单因素分析中，患有慢性肾脏病（CKD）、糖尿病的患者以及接受更高日剂量阿昔洛韦治疗的患者更常发生 AKI。AKI 患者的年龄也呈增加趋势。在二项逻辑回归模型中，只有 CKD 和日剂量仍然是显著的独立因素。
AKI 是静脉用阿昔洛韦的一个重要副作用，其发生率与氨基糖苷类等已确立的肾毒性药物相当。患有预先存在的 CKD 或接受更高总剂量的患者风险最大，这进一步强调了根据理想体重和基线肾功能适当调整剂量的临床重要性。
