Duncan Andrew D S, Hapca Simona, De Souza Nicosha, Morales Daniel, Bell Samira
Renal Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Division of Population Health and Genomics, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
Age Ageing. 2020 Oct 23;49(6):1042-1047. doi: 10.1093/ageing/afaa079.
to establish and quantify any observable association between the exposure to community prescriptions for quinine and acute kidney injury (AKI) events in a population of older adults.
two observational studies using the same dataset, a retrospective longitudinal cohort study and a self-controlled case series (SCCS).
NHS health board in Scotland.
older adults (60+ years) who received quinine prescriptions in Tayside, Scotland, between January 2004 and December 2015. The first study included 12,744 individuals. The SCCS cohort included 5,907 people with quinine exposure and more than or equal to one AKI event.
in the first study, multivariable logistic regression was used to calculate odds ratios (ORs) for AKI comparing between episodes with and without recent quinine exposure after adjustment for demographics, comorbidities and concomitant medications. The SCCS study divided follow-up for each individual into periods 'on' and 'off' quinine, calculating incidence rate ratios (IRRs) for AKI adjusting for age.
during the study period, 273,596 prescriptions for quinine were dispensed in Tayside. A total of 13,616 AKI events occurred during follow-up (crude incidence 12.5 per 100 person-years). In the first study, exposure to quinine before an episode of care was significantly associated with an increased probability of AKI (adjusted OR = 1.27, 95% confidence interval (CI) 1.21-1.33). In the SCCS study, exposure to quinine was associated with an increased relative incidence of AKI compared to unexposed periods (IRR = 1.20, 95% CI 1.15-1.26), with the greatest risk observed within 30 days following quinine initiation (IRR = 1.48, 95% CI 1.35-1.61).
community prescriptions for quinine in an older adult population are associated with an increased risk of AKI.
在老年人群中建立并量化服用奎宁的社区处方暴露与急性肾损伤（AKI）事件之间的任何可观察到的关联。
两项使用相同数据集的观察性研究，一项回顾性纵向队列研究和一项自控病例系列研究（SCCS）。
苏格兰的NHS健康委员会。
2004年1月至2015年12月期间在苏格兰泰赛德接受奎宁处方的老年人（60岁及以上）。第一项研究纳入了12,744名个体。SCCS队列包括5,907名有奎宁暴露且发生过一次及以上AKI事件的人。
在第一项研究中，多变量逻辑回归用于计算在调整人口统计学、合并症和伴随用药后，近期有奎宁暴露与无奎宁暴露的发作期相比发生AKI的比值比（OR）。SCCS研究将每个个体的随访分为服用奎宁的“服药期”和“停药期”，计算调整年龄后的AKI发病率比（IRR）。
在研究期间，泰赛德共发放了273,596份奎宁处方。随访期间共发生13,616例AKI事件（粗发病率为每100人年12.5例）。在第一项研究中，在护理发作前服用奎宁与AKI发生概率增加显著相关（调整后的OR = 1.27，95%置信区间（CI）1.21 - 1.33）。在SCCS研究中，与未暴露期相比，服用奎宁与AKI相对发病率增加相关（IRR = 1.20，95% CI 1.15 - 1.26），在开始服用奎宁后的30天内观察到的风险最高（IRR = 1.48，95% CI 1.35 - 1.61）。
老年人群中奎宁的社区处方与AKI风险增加相关。
