非甾体抗炎药处方与活跃中青年人群肾脏病的关联。
Association of Nonsteroidal Anti-inflammatory Drug Prescriptions With Kidney Disease Among Active Young and Middle-aged Adults.
机构信息
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Division of Nephrology, Department of Medicine, Uniformed Services University, Bethesda, Maryland.
出版信息
JAMA Netw Open. 2019 Feb 1;2(2):e187896. doi: 10.1001/jamanetworkopen.2018.7896.
IMPORTANCE
Concern about the renal effects of nonsteroidand al anti-inflammatory drugs (NSAIDs) among young, healthy adults has been limited, but more attention may be warranted given the prevalent use of these agents.
OBJECTIVE
To test for associations between dispensed NSAIDs and incident acute kidney injury and chronic kidney disease while controlling for other risk factors.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, longitudinal cohort study used deidentified medical and administrative data on 764 228 active-duty US Army soldiers serving between January 1, 2011, and December 31, 2014. Analysis was conducted from August 1 to November 30, 2018. All individuals new to Army service were included in the analysis. Persons already serving in January 2011 were required to have at least 7 months of observable time to eliminate those with kidney disease histories.
EXPOSURES
Mean total defined daily doses of prescribed NSAIDs dispensed per month in the prior 6 months.
MAIN OUTCOMES AND MEASURES
Incident outcomes were defined by diagnoses documented in health records and a military-specific digital system.
RESULTS
Among the 764 228 participants (655 392 [85.8%] men; mean [SD] age, 28.6 [7.9] years; median age, 27.0 years [interquartile range, 22.0-33.0 years]), 502 527 (65.8%) were not dispensed prescription NSAIDs in the prior 6 months, 137 108 (17.9%) were dispensed 1 to 7 mean total defined daily doses per month, and 124 594 (16.3%) received more than 7 defined daily doses per month. There were 2356 acute kidney injury outcomes (0.3% of participants) and 1634 chronic kidney disease outcomes (0.2%) observed. Compared with participants who received no medication, the highest exposure level was associated with significantly higher adjusted hazard ratios (aHRs) for acute kidney injury (aHR, 1.2; 95% CI, 1.1-1.4) and chronic kidney disease (aHR, 1.2; 95% CI, 1.0-1.3), with annual outcome excesses per 100 000 exposed individuals totaling 17.6 cases for acute kidney injury and 30.0 cases for chronic kidney disease.
CONCLUSIONS AND RELEVANCE
Modest but statistically significant associations were noted between the highest observed doses of NSAID exposure and incident kidney problems among active young and middle-aged adults.
重要性
对于年轻健康成年人，非甾体抗炎药（NSAIDs）的肾脏影响的关注是有限的，但鉴于这些药物的普遍使用，可能需要更多的关注。
目的
在控制其他风险因素的情况下，测试配药的 NSAIDs 与急性肾损伤和慢性肾脏病之间的关联。
设计、设置和参与者： 这是一项回顾性、纵向队列研究，使用了 2011 年 1 月 1 日至 2014 年 12 月 31 日期间 764228 名现役美国陆军士兵的匿名医疗和行政数据。分析于 2018 年 8 月 1 日至 11 月 30 日进行。所有新入伍的人员都包括在分析中。2011 年 1 月已经服役的人员必须至少有 7 个月的可观察时间，以排除有肾病病史的人员。
暴露
过去 6 个月中每月配药的处方 NSAIDs 的平均总日剂量。
主要结果和测量
记录在健康记录和军事特定数字系统中的诊断来定义事件结果。
结果
在 764228 名参与者中（655392 [85.8%] 名男性；平均[标准差]年龄 28.6 [7.9] 岁；中位数年龄 27.0 岁[四分位间距 22.0-33.0 岁]），502527 名（65.8%）参与者在过去 6 个月内未配药 NSAIDs，137108 名（17.9%）参与者每月配药 1 至 7 个平均总日剂量，124594 名（16.3%）参与者每月配药超过 7 个日剂量。共观察到 2356 例急性肾损伤结果（0.3%的参与者）和 1634 例慢性肾脏病结果（0.2%）。与未接受药物治疗的参与者相比，最高暴露水平与急性肾损伤（调整后的危险比[aHR]，1.2；95%CI，1.1-1.4）和慢性肾脏病（aHR，1.2；95%CI，1.0-1.3）的调整后风险比显著更高，每 100000 名暴露个体的年度结果超额总数为急性肾损伤 17.6 例，慢性肾疾病 30.0 例。
结论和相关性
在年轻和中年现役人群中，观察到最高剂量 NSAIDs 暴露与新发肾脏问题之间存在适度但具有统计学意义的关联。
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