Wang Hai, Liu Tong, Li Qinglin, Cui Ruixia, Fan Xueying, Tong Yingmu, Ma Shuzhen, Liu Chang, Zhang Jingyao
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China.
Department of Laboratory Medicine Center, Xi'an People's Hospital (The Fourth Hospital of Xi'an), Shaanxi, China.
Front Pharmacol. 2022 May 17;13:843210. doi: 10.3389/fphar.2022.843210. eCollection 2022.
NSAIDs are one of the most frequently used medications and a risk factor for AKI. However, the optimal time of NSAIDs in patients with AKI is unknown. A secondary analysis of a multicenter, randomized clinical trial including adult inpatients with acute kidney injury was performed. Univariate, multivariate, and subgroup analyses were used to explore the impact of NSAIDs during the early onset of AKI on the outcome of patients with AKI. A total of 6,030 patients with AKI were enrolled in the study. Following are the findings of the multi-factor analysis: NSAID treatments within 72 and 24 h before the onset of AKI were not associated with AKI progression, dialysis, or discharge from dialysis; only NSAID treatment within the 24-h onset of AKI was associated with these outcomes, and their OR values were independently 1.50 (95% CI: 1.02-2.19, = 0.037), 4.20 (95% CI: 1.47-11.97, = 0.007), and 0.71 (95% CI: 0.54-0.92, = 0.011); only NSAID treatment within the 24-h onset of AKI would decrease the 14-day mortality, and the OR value was 0.52 (95% CI: 0.33-0.82, = 0.005). The subgroup analysis revealed that in patients with age ≥65 years, CKD (chronic kidney disease), congestive heart failure, hypertension, and liver disease, NSAID treatments within the 24-h onset of AKI would deteriorate the outcome of patients with AKI. Before an early onset of AKI, NSAID treatment might be safe, but during the onset of AKI, even early NSAID treatment would deteriorate the outcome of patients with AKI.
非甾体抗炎药（NSAIDs）是最常用的药物之一，也是急性肾损伤（AKI）的一个危险因素。然而，NSAIDs在AKI患者中的最佳使用时间尚不清楚。对一项多中心随机临床试验进行了二次分析，该试验纳入了成年急性肾损伤住院患者。采用单因素、多因素和亚组分析来探讨AKI早期使用NSAIDs对AKI患者预后的影响。共有6030例AKI患者纳入该研究。多因素分析结果如下：AKI发作前72小时和24小时内使用NSAIDs与AKI进展、透析或停止透析无关；仅AKI发作24小时内使用NSAIDs与这些结局相关，其比值比（OR）值分别为1.50（95%置信区间：1.02 - 2.19，P = 0.037）、4.20（95%置信区间：1.47 - 11.97，P = 0.007）和0.71（95%置信区间：0.54 - 0.92，P = 0.011）；仅AKI发作24小时内使用NSAIDs会降低14天死亡率，OR值为0.52（95%置信区间：0.33 - 0.82，P = 0.005）。亚组分析显示，在年龄≥65岁、患有慢性肾脏病（CKD）、充血性心力衰竭、高血压和肝病的患者中，AKI发作24小时内使用NSAIDs会使AKI患者的预后恶化。在AKI早期发作之前，NSAID治疗可能是安全的，但在AKI发作期间，即使是早期使用NSAIDs也会使AKI患者的预后恶化。
