He Yanfang, Mo Liqian, Li Juan, Lu Dongying, Niu Jinlei, Li Ying, Zeng Qiying, Gao Yueming
Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Med (Lausanne). 2024 Dec 10;11:1488773. doi: 10.3389/fmed.2024.1488773. eCollection 2024.
Gabapentinoids, such as gabapentin and pregabalin, are opioid substitutes commonly included in perioperative multimodal analgesia regimens. We investigated whether the initiation of gabapentin and pregabalin during the perioperative period have varying effects on the adverse renal outcomes.
This study included adult participants who received surgery in the INSPIRE database. The exposure of interest was the initiation of pregabalin or gabapentin during the perioperative period. The primary outcome was renal function decline. Secondary outcomes included incident chronic kidney disease (CKD), hospital-acquired acute kidney injury (AKI), and in-hospital mortality. We conducted a propensity score to balance the baseline characteristics. Cox proportional hazard regression was used to estimate the hazard ratio (HR) of the initiation of gabapentin compared with pregabalin.
Among 640 pairs of pregabalin and gabapentin initiators in the matched cohort, the initiation of gabapentin was associated with a higher risk of kidney function decline (HR, 1.40; 95% confidence interval [CI], 1.04-1.89) as compared with pregabalin. After excluding participants who were diagnosed with CKD at the baseline, the initiation of gabapentin was associated with a higher risk of incident CKD (HR, 1.46; 95% CI, 1.03-2.05) as compared with pregabalin. For the in-hospital outcomes, the proportion of AKI and mortality were similar between participants initiating gabapentin and pregabalin. In addition, the risk of kidney function decline did not vary across each subgroup.
The initiation of gabapentin during the perioperative period was associated with a higher risk of kidney function decline and incident CKD as compared with pregabalin.
加巴喷丁类药物，如加巴喷丁和普瑞巴林，是围手术期多模式镇痛方案中常用的阿片类替代药物。我们研究了围手术期开始使用加巴喷丁和普瑞巴林对不良肾脏结局是否有不同影响。
本研究纳入了在INSPIRE数据库中接受手术的成年参与者。感兴趣的暴露因素是围手术期开始使用普瑞巴林或加巴喷丁。主要结局是肾功能下降。次要结局包括新发慢性肾脏病（CKD）、医院获得性急性肾损伤（AKI）和住院死亡率。我们进行了倾向评分以平衡基线特征。采用Cox比例风险回归来估计加巴喷丁与普瑞巴林起始使用的风险比（HR）。
在匹配队列中的640对普瑞巴林和加巴喷丁起始使用者中，与普瑞巴林相比，加巴喷丁起始使用与肾功能下降风险较高相关（HR，1.40；95%置信区间[CI]，1.04 - 1.89）。在排除基线时被诊断为CKD的参与者后，与普瑞巴林相比，加巴喷丁起始使用与新发CKD风险较高相关（HR，1.46；95% CI，1.03 - 2.05）。对于住院结局，开始使用加巴喷丁和普瑞巴林的参与者之间AKI和死亡率的比例相似。此外，肾功能下降的风险在每个亚组中没有差异。
与普瑞巴林相比，围手术期开始使用加巴喷丁与肾功能下降和新发CKD风险较高相关。
