Pérez Gutthann S, García Rodríguez L A, Raiford D S, Duque Oliart A, Ris Romeu J
Pharmacoepidemiology Research, Ciba-Geigy, Spain.
Arch Intern Med. 1996 Nov 25;156(21):2433-9. doi: 10.1001/archinte.1996.00440200041005.
Few studies have evaluated the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of idiopathic acute renal failure (ARF) in the general population.
Population-based case-control study among persons in the Canadian province of Saskatchewan who received at least 1 NSAID prescription between January 1, 1982, and December 31, 1986. Health department databases were used for case detection, as the sampling frame for selecting controls (n = 1997), and as the primary source of information on drug use and comorbidity. A total of 306 hospital records were reviewed. Twenty-eight patients who were hospitalized fulfilled the diagnostic criteria for ARF.
The incidence rate of hospitalization for ARF among the general population not exposed to NSAIDs was 2 per 100000 person-years. Current exposure to NSAIDs, acetylsalicylic acid and other nephrotoxic drugs, male gender, increasing age, cardiovascular comorbidity, and recent hospitalization for disorders other than renal were found to be independent risk factors for ARF. Current NSAID users had an adjusted odds ratio for ARF of 4.1 (95% confidence interval, 1.5-10.8). The risk of ARF was especially high during the first month of use (odds ratio, 8.5). For prescribed dose, we found that users of high daily doses of NSAIDs experienced an odds ratio of 9.8 for ARF.
In the general population, hospitalizations for ARF were found to be a rare condition. The 4-fold increase in risk associated with NSAID use was dose-dependent and occurred especially during the first month of therapy. Concurrent comedication with other potentially nephrotoxic agents should be prescribed with care, especially in the elderly.
很少有研究评估非甾体抗炎药（NSAIDs）的使用与普通人群特发性急性肾衰竭（ARF）风险之间的关联。
对加拿大萨斯喀彻温省在1982年1月1日至1986年12月31日期间至少开具过1张NSAIDs处方的人群进行基于人群的病例对照研究。卫生部门数据库用于病例检测、作为选择对照（n = 1997）的抽样框架以及作为药物使用和合并症信息的主要来源。共审查了306份医院记录。28名住院患者符合ARF诊断标准。
未接触NSAIDs的普通人群中ARF住院发病率为每10万人年2例。当前接触NSAIDs、乙酰水杨酸和其他肾毒性药物、男性、年龄增加、心血管合并症以及近期因非肾脏疾病住院被发现是ARF的独立危险因素。当前NSAIDs使用者发生ARF的调整比值比为4.1（95%置信区间，1.5 - 10.8）。使用的第一个月内ARF风险尤其高（比值比，8.5）。对于规定剂量，我们发现每日高剂量NSAIDs使用者发生ARF的比值比为9.8。
在普通人群中，ARF住院情况较为罕见。与NSAIDs使用相关的风险增加4倍呈剂量依赖性，尤其在治疗的第一个月出现。与其他潜在肾毒性药物同时用药时应谨慎处方，尤其是在老年人中。
