Rey Amayelle, Gras Valérie, Moragny Julien, Choukroun Gabriel, Masmoudi Kamel, Liabeuf Sophie
Division of Clinical Pharmacology, Pharmacoepidemiology Department, Amiens University Hospital, Amiens, France.
MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France.
Front Pharmacol. 2022 Jul 5;13:899164. doi: 10.3389/fphar.2022.899164. eCollection 2022.
Drug-induced acute kidney injury (AKI) can occur both in primary care (i.e., community-acquired AKI (CA-AKI)) and in hospital settings (i.e., hospital-acquired AKI (HA-AKI)). The reported prevalence of these events varies markedly from one study to another, mainly due to differences in the study design. To estimate the frequency of drug-induced AKIs (both CA-AKIs and HA-AKIs) observed in a French university hospital, we applied the capture-recapture method to 1) the French national pharmacovigilance database (FPVD) and 2) a cohort of hospitalized patients with drug-induced AKIs (documented by analyzing the French national hospital discharge database and the patients' electronic medical records). Drug-induced AKIs were determined according to the Naranjo algorithm and then categorized as CA-AKIs or HA-AKIs. A total number of 1,557 episodes of AKI were record during the study period, of them, the estimated total number of drug-induced AKIs was 593 [95% confidence interval (CI): 485-702], and the estimated prevalence was 38.1% [95%CI: 35.67-40.50]. The prevalences of HA-AKIs and CA-AKIs were similar (39.4% [36.24-42.54] and 37.4% [33.67-41.21], respectively). Only 6.1% of the drug-induced AKIs were recorded in the FPVD, and the proportions of recorded HA-AKIs and CA-AKI differed markedly (3.0% vs. 10.5%, respectively). One of the most frequently involved drug classes were antibiotics in the HA-AKI subgroup (13.0%) and antineoplastics in the CA-AKI subgroup (8.3%). Application of the capture-recapture method to two incomplete data sources can improve the ability to identify and quantify adverse drug reactions like AKIs. The frequency of drug-induced AKI is relatively high and is probably underestimated. The clinical management of an AKI might depend on where it originated.
药物性急性肾损伤（AKI）在初级保健机构（即社区获得性AKI（CA-AKI））和医院环境中（即医院获得性AKI（HA-AKI））均可发生。这些事件的报告患病率在不同研究之间差异显著，主要是由于研究设计的不同。为了估计在一家法国大学医院中观察到的药物性AKI（包括CA-AKI和HA-AKI）的发生率，我们将捕获-再捕获方法应用于：1）法国国家药物警戒数据库（FPVD）；2）一组药物性AKI的住院患者队列（通过分析法国国家医院出院数据库和患者的电子病历记录）。根据纳朗霍算法确定药物性AKI，然后将其分类为CA-AKI或HA-AKI。在研究期间共记录了1557例AKI发作，其中，药物性AKI的估计总数为593例[95%置信区间（CI）：485-702]，估计患病率为38.1%[95%CI：35.67-40.50]。HA-AKI和CA-AKI的患病率相似（分别为39.4%[36.24-42.54]和37.4%[33.67-41.21]）。FPVD中仅记录了6.1%的药物性AKI，记录的HA-AKI和CA-AKI的比例差异显著（分别为3.0%和10.5%）。在HA-AKI亚组中，最常涉及的药物类别之一是抗生素（13.0%），而在CA-AKI亚组中是抗肿瘤药（8.3%）。将捕获-再捕获方法应用于两个不完整的数据源可以提高识别和量化如AKI等药物不良反应的能力。药物性AKI的发生率相对较高，可能被低估。AKI的临床管理可能取决于其起源地。
