Lin Sharon X, Phillips Thomas, Culliford David, Edwards Christopher, Holroyd Christopher, Ibrahim Kinda, Barrett Ravina, Howard Clare, Johnson Ruth, Adams Jo, Stammers Mathew, Rischin Adam, Rutter Paul, Barnes Nicola, Roderick Paul J, Fraser Simon Ds
National Institute for Health Research Wessex Applied Research Collaboration, University of Southampton, Southampton General Hospital, Southampton, UK.
University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK.
BJGP Open. 2022 Mar 22;6(1). doi: 10.3399/BJGPO.2021.0208. Print 2022 Mar.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions.
To measure the extent of NSAID prescribing in an adult population, the degree to which patients with potential higher risk of AKI were exposed to NSAIDs, and to quantify their risk of AKI.
DESIGN & SETTING: Retrospective 2-year closed-cohort study.
A retrospective cohort of adults was identified from a pseudonymised electronic primary care database in Hampshire, UK. The cohort had clinical information, prescribing data, and complete GP- and hospital-ordered biochemistry data. NSAID exposure (minimum one prescription in a 2-month period) was categorised as never, intermittent, and continuous, and first AKI using the national AKI e-alert algorithm. Descriptive statistics and logistic regression were used to explore NSAID prescribing patterns and AKI risk.
The baseline population was 702 265. NSAID prescription fell from 19 364 (2.8%) to 16 251 (2.4%) over 2 years. NSAID prescribing was positively associated with older age, female sex, greater socioeconomic deprivation, and certain comorbidities (diabetes, hypertension, osteoarthritis, and rheumatoid arthritis) and negatively with cardiovascular disease (CVD) and heart failure. Among those prescribed NSAIDs, AKI was associated with older age, greater deprivation, chronic kidney disease (CKD), CVD, heart failure, diabetes, and hypertension.
Despite generally good prescribing practice, NSAID prescribing was identified in some people at higher risk of AKI (for example, patients with CKD and older) for whom medication review and NSAID deprescribing should be considered.
非甾体抗炎药（NSAIDs）常用于止痛和抗炎。NSAIDs的并发症包括急性肾损伤（AKI），通过增加发病率、死亡率和住院率给患者和医疗服务带来负担。
衡量成年人群中NSAIDs的处方开具程度、急性肾损伤潜在高风险患者接触NSAIDs的程度，并量化他们发生急性肾损伤的风险。
为期2年的回顾性封闭队列研究。
从英国汉普郡一个化名的电子初级保健数据库中确定一个成年回顾性队列。该队列有临床信息、处方数据以及完整的全科医生和医院安排的生化数据。NSAIDs暴露（2个月内至少有一次处方）分为从未暴露、间歇性暴露和持续性暴露，并使用国家急性肾损伤电子警报算法确定首次急性肾损伤情况。使用描述性统计和逻辑回归来探讨NSAIDs的处方模式和急性肾损伤风险。
基线人群为702265人。2年内NSAIDs处方量从19364例（2.8%）降至16251例（2.4%）。NSAIDs处方开具与年龄较大、女性、社会经济剥夺程度较高以及某些合并症（糖尿病、高血压、骨关节炎和类风湿关节炎）呈正相关，与心血管疾病（CVD）和心力衰竭呈负相关。在开具NSAIDs处方的人群中，急性肾损伤与年龄较大、剥夺程度较高、慢性肾脏病（CKD）、心血管疾病、心力衰竭、糖尿病和高血压有关。
尽管总体处方实践良好，但在一些急性肾损伤高风险人群（如慢性肾脏病患者和老年人）中仍发现有NSAIDs处方开具情况，对此应考虑进行用药评估和停用NSAIDs。
