Zhang Ruiqiu, Liu Yanxin, Cao Jia, Lao Jiahui, Wang Baobao, Li Siwen, Huang Xin, Tang Fang, Li Xiao
Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China.
School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.
Front Pharmacol. 2022 Jul 22;13:924173. doi: 10.3389/fphar.2022.924173. eCollection 2022.
Diuretics have been one of the well-known nephrotoxic drugs which can lead to acute kidney injury (AKI). However, there are few real-world studies on the incidence of AKI in hospitalized patients received diuretics. In the present study, a single-center retrospective study was conducted in our center. The clinical data of hospitalized patients received diuretics from January 2018 to December 2020 was retrospectively analyzed. Among the 18,148 hospitalized patients included in the study, 2,589 patients (14.26%) were judged as incidence with AKI, while only 252 patients were diagnosed with AKI in the medical record. Among diuretics drugs in the study, the incidence rate of AKI with torasemide was the highest with 21.62%, and hydrochlorothiazide had the lowest incidence rate (6.80%). The multiple logistic regression analysis suggested that complicated with hypertension, anemia, pneumonia, shock, sepsis, heart failure, neoplastic diseases, combined use of proton pump inhibitors (PPI) were independent risk factors for AKI related to diuretics. The logic regression models for diuretics related AKI were developed based on the included data. The model for diuretics-AKI achieved the area under the receiver operating characteristic curves (AUC) with 0.79 on 10-fold cross validation. It is urgent to improve the understanding and attention of AKI in patients received diuretics for medical workers, and the assessment of risk factors before the use of diuretics should be contributed to the early prevention, diagnosis and treatment of AKI, and ultimately reducing morbidity and improving prognosis.
利尿剂一直是众所周知的可导致急性肾损伤(AKI)的肾毒性药物之一。然而,关于接受利尿剂治疗的住院患者中AKI发生率的真实世界研究较少。在本研究中,我们中心进行了一项单中心回顾性研究。对2018年1月至2020年12月接受利尿剂治疗的住院患者的临床资料进行了回顾性分析。在纳入研究的18148例住院患者中,2589例(14.26%)被判定为发生了AKI,而病历中仅252例被诊断为AKI。在研究的利尿剂药物中,托拉塞米导致AKI的发生率最高,为21.62%,氢氯噻嗪的发生率最低(6.80%)。多因素logistic回归分析表明,合并高血压、贫血、肺炎、休克、脓毒症、心力衰竭、肿瘤性疾病、联合使用质子泵抑制剂(PPI)是与利尿剂相关的AKI的独立危险因素。基于纳入的数据建立了与利尿剂相关的AKI的逻辑回归模型。在10倍交叉验证中,利尿剂-AKI模型的受试者工作特征曲线下面积(AUC)为0.79。医务人员迫切需要提高对接受利尿剂治疗患者中AKI的认识和关注,在使用利尿剂前对危险因素进行评估应有助于AKI的早期预防、诊断和治疗,并最终降低发病率和改善预后。