Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.
Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins), EA 7449, 35000, Rennes, France.
J Nephrol. 2021 Oct;34(5):1711-1723. doi: 10.1007/s40620-020-00952-5. Epub 2021 Apr 20.
The association between the use of potentially nephrotoxic drugs [Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Iodinated Contrast Agents, Proton Pump Inhibitors (PPIs)] and emergency start of dialysis in patients with chronic kidney disease has not been well explored, although these compounds are commonly prescribed or available without prescription.
In this study, the Renal Epidemiology Information Network (REIN) registry data of all patients ≥ 18 years of age who started dialysis in France in 2015 were matched with those in the French National Health Insurance Database. The association between clinical characteristics, nephrotoxic drug exposure and emergency dialysis start was investigated. Patients were categorized into four classes of NSAID and PPI exposure (new, current, past, no user) on the basis of the pre-dialysis exposure period (1-30, 31-90, and 91-365 days). For iodinated contrast agents, exposure in the 72 h and 7 days before dialysis was analyzed.
Among the 8805 matched patients, 30.2% needed to start dialysis in emergency. After adjustment for socio-demographic and clinical variables, new NSAID users were more likely to experience emergency dialysis start [OR = 1.95; 95% CI (1.1-3.4)]. This association was higher for new than for current users [OR: 1.44; 95% CI (1.08-1.92)]. Emergency dialysis start was also associated with iodinated contrast agent exposure in the previous 7 days [OR: 1.44; 95% CI (1.2-1.7)]. No significant relationship was detected between PPIs and emergency dialysis start.
Using both clinical and healthcare data, this study shows that emergency dialysis start is independently associated with recent exposure to NSAIDs and iodinated contrast agents. This suggests the need to strengthen the information given to healthcare professionals and patients with regard to nephrotoxic drugs.
尽管非甾体抗炎药（NSAIDs）、碘造影剂、质子泵抑制剂（PPIs）等潜在肾毒性药物在慢性肾脏病患者中常被处方或无需处方即可获得，但它们与急诊透析开始之间的关系尚未得到充分探讨。
本研究使用法国肾流行病学信息网（REIN）登记数据库中所有于 2015 年在法国开始透析的≥18 岁患者的数据，与法国国家健康保险数据库进行匹配。研究调查了临床特征、肾毒性药物暴露与急诊透析开始之间的关系。根据透析前暴露期（1-30、31-90 和 91-365 天），将患者分为 NSAID 和 PPI 暴露（新用、现用、曾用和未用）4 个类别。对于碘造影剂，分析了透析前 72 小时和 7 天内的暴露情况。
在 8805 例匹配患者中，30.2%需要急诊透析。在调整了社会人口统计学和临床变量后，新 NSAID 用户更有可能经历急诊透析开始[比值比（OR）=1.95；95%置信区间（CI）（1.1-3.4）]。与现用患者相比，新用患者的这种关联更高[OR：1.44；95%CI（1.08-1.92）]。急诊透析开始也与前 7 天内碘造影剂暴露有关[OR：1.44；95%CI（1.2-1.7）]。PPIs 与急诊透析开始之间无显著相关性。
本研究结合临床和医疗保健数据表明，急诊透析开始与 NSAIDs 和碘造影剂的近期暴露独立相关。这表明需要加强向医护人员和肾毒性药物患者提供相关信息。
