根据给药途径，慢性肾脏病患者使用非甾体类抗炎药与急性不良肾脏事件风险
Non-steroidal anti-inflammatory drugs in chronic kidney disease and risk of acute adverse kidney events according to route of administration.
作者信息
Teo Su Hooi, Tan Ngiap Chuan, Choo Jason Chon Jun, Kwek Jia Liang, Kadir Hanis Bte Abdul, Bee Yong Mong, Huang Huijun, Kaushik Manish, Ang Andrew Teck Wee, Lim Cynthia Ciwei
机构信息
Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
SingHealth Polyclinic, Singapore, Singapore.
出版信息
Int Urol Nephrol. 2023 Mar;55(3):679-686. doi: 10.1007/s11255-022-03344-9. Epub 2022 Sep 5.
BACKGROUND
Topical non-steroidal anti-inflammatory drugs (NSAIDs) have lower risks for cardiovascular disease and gastrointestinal adverse effects compared to oral NSAIDs, but there are little data regarding their kidney risks in chronic kidney disease (CKD). We evaluated the risk of adverse acute kidney outcomes in CKD according to route of NSAID administration.
METHODS
Retrospective cohort study of adults with CKD (eGFR less than 60 ml/min/1.73 m) who received prescriptions between 2015 and 2017 from a major healthcare cluster in Singapore. The adverse acute kidney outcomes were acute kidney injury (AKI) and need for nephrology specialist consult within 30 days.
RESULTS
Among 6298 adults with CKD (mean age 72.1 ± 13.3 years and eGFR 41.9 ± 12.2 ml/min/1.73 m), systemic and topical NSAIDs were prescribed in 16.7% and 32.0%, respectively. Incident AKI (any severity), KDIGO Stage 2 or 3 AKI, and need for nephrology specialist consult occurred in 16.7%, 2.6%, and 10.6% of the study cohort, respectively. After adjusting for age, diabetes, recent cardiovascular hospitalization, baseline eGFR, RAAS blocker and diuretic, systemic NSAIDs, and topical NSAIDs, compared with the no-NSAID group, were independently associated with incident AKI [adjusted OR 1.77 (95% CI 1.46-2.15) and 1.38 (1.18-1.63), respectively]. Moderate and severe AKI (adjusted OR 1.68, 95% CI 1.09-2.58, p = 0.02) and need for nephrology consults (adjusted OR 1.41, 95% CI 1.09-1.82, p = 0.008) were also increased in systemic NSAIDs.
CONCLUSION
Among adults with CKD, both systemic and topical NSAIDs were independently associated with acute adverse kidney outcomes.
背景
与口服非甾体抗炎药（NSAIDs）相比，外用NSAIDs的心血管疾病风险和胃肠道不良反应风险更低，但关于其在慢性肾脏病（CKD）中的肾脏风险的数据较少。我们根据NSAIDs的给药途径评估了CKD患者发生不良急性肾结局的风险。
方法
对2015年至2017年期间从新加坡一个主要医疗集团接受处方的CKD成人患者（估算肾小球滤过率低于60 ml/min/1.73 m²）进行回顾性队列研究。不良急性肾结局为急性肾损伤（AKI）和30天内需要肾内科专科会诊。
结果
在6298例CKD成人患者（平均年龄72.1±13.3岁，估算肾小球滤过率41.9±12.2 ml/min/1.73 m²）中，分别有16.7%和32.0%的患者使用了全身性和外用NSAIDs。研究队列中分别有16.7%、2.6%和10.6%的患者发生了新发AKI（任何严重程度）、KDIGO 2期或3期AKI以及需要肾内科专科会诊。在调整了年龄、糖尿病、近期心血管住院史、基线估算肾小球滤过率、肾素-血管紧张素-醛固酮系统阻滞剂和利尿剂、全身性NSAIDs以及外用NSAIDs后，与未使用NSAIDs组相比，全身性NSAIDs和外用NSAIDs均与新发AKI独立相关[调整后的比值比分别为1.77（95%置信区间1.46-2.15）和1.38（1.18-1.63）]。全身性NSAIDs还会增加中度和重度AKI（调整后的比值比为1.68，95%置信区间1.09-2.58，p=0.02）以及需要肾内科会诊的风险（调整后的比值比为1.41，95%置信区间1.09-1.82，p=0.008）。
结论
在CKD成人患者中，全身性和外用NSAIDs均与急性不良肾结局独立相关。
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