Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, Rennes, France.
Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, Rennes, France.
Eur J Hosp Pharm. 2022 Nov;29(6):359-361. doi: 10.1136/ejhpharm-2020-002550. Epub 2021 Jan 21.
Concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) with diuretics and renin-angiotensin-aldosterone system inhibitors (RAASI) has been associated with an increased risk of developing acute kidney injury (AKI) in the ambulatory setting. There is currently no information on AKI prevalence in hospitalised patients where initiation of NSAID prescription is quite frequent. The aim of our study was to assess the prevalence of AKI in patients treated with diuretics and/or RAASI in the hospital setting when NSAIDs are initiated.
This was a retrospective single centre study on inpatients receiving triple or dual association treatment. AKI was established according to evidence-based clinical practice guidelines in kidney disease (Kidney Disease Improving Global Outcome, KDIGO) using the following criteria : increase in serum creatinine (SCr) by ≥0.3 mg/dL (or ≥26.5 µmol/L) within 48 hours, or increase in SCr to ≥1.5 times baseline occurring within the last 7 days.
AKI was identified in 5 of 151 patients (3.3%) treated with both diuretics and RAASI in whom NSAIDs were initiated, with a 49 µM average increase in SCr within 48 hours compared with baseline. AKI was identified in 2 of 117 (1.7%) patients treated with diuretics and NSAIDs, and in 1 of 427 (0.23%) patients treated with RAASI and NSAIDs. The average increase in SCr within 2 days was 29 µM. No AKI was identified in a control group of 1886 patients treated with diuretics and RAASI but with no initiation of NSAIDs during their hospitalisation.
Initiation of NSAID therapy in hospitalised patients already being treated with diuretics and RAASI is a risk factor for AKI. The risk of AKI with the triple association appeared higher than with the dual association treatment.
在门诊环境中，非甾体抗炎药（NSAIDs）与利尿剂和肾素-血管紧张素-醛固酮系统抑制剂（RAASI）联合使用与发生急性肾损伤（AKI）的风险增加相关。目前，在 NSAIDs 处方起始较为频繁的住院患者中，关于 AKI 患病率的信息尚不清楚。我们的研究目的是评估在住院患者中开始使用 NSAIDs 时，同时使用利尿剂和/或 RAASI 治疗时 AKI 的患病率。
这是一项回顾性单中心研究，纳入接受三联或双联联合治疗的住院患者。AKI 根据肾脏病的循证临床实践指南（改善全球肾脏病预后组织，KDIGO）确定，使用以下标准：48 小时内血清肌酐（SCr）升高≥0.3mg/dL（或≥26.5μmol/L），或在过去 7 天内 SCr 升高至基线值的 1.5 倍以上。
在 151 例同时使用利尿剂和 RAASI 并开始使用 NSAIDs 的患者中，有 5 例（3.3%）发生 AKI，与基线相比，48 小时内 SCr 平均升高 49µM。在 117 例接受利尿剂和 NSAIDs 治疗的患者中，有 2 例（1.7%）发生 AKI，在 427 例接受 RAASI 和 NSAIDs 治疗的患者中，有 1 例（0.23%）发生 AKI。在 2 天内 SCr 平均升高 29µM。在未开始 NSAIDs 治疗的 1886 例同时接受利尿剂和 RAASI 治疗的患者中，未发现 AKI。
在已接受利尿剂和 RAASI 治疗的住院患者中开始 NSAID 治疗是 AKI 的一个危险因素。三联联合治疗的 AKI 风险似乎高于双联联合治疗。
