Proton pump inhibitors and acute kidney injury: a nested case-control study.
Proton pump inhibitors and acute kidney injury: a nested case-control study.
复制标题
DOI：
10.1186/1471-2369-14-150
复制
发表时间：
2013-07-16
期刊：
影响因子：
2.3
通讯作者：
Cochran GL
中科院分区：
文献类型：
--
作者：
Klepser DG;Collier DS;Cochran GL
质子泵抑制剂（PPI）是一种广泛使用的治疗胃食管反流病和其他胃肠道酸相关疾病的药物。作为一类，PPI已证明具有良好的安全性特征。然而，病例报告表明，这类药物可能与急性肾损伤有关，而急性肾损伤又可能导致慢性损伤或衰竭。本研究的目的是确定PPI与肾衰竭之间是否存在相关性，并估计PPI使用与肾脏疾病之间关系的效应量。在中西部一个州的私人保险人群中进行了一项巢式病例对照研究，包括2002年9月至2005年11月期间在保险公司连续登记至少24个月的184，480名18岁或以上的患者。在符合研究条件的患者中，854例被确定为至少有两次急性肾脏疾病诊断的索赔。根据年龄、性别、居住县和进入队列的日期，将病例与最多4个对照组（n = 3，289）随机匹配。从住院、专业和处方索赔数据中收集患者人口统计学数据、PPI使用、疾病和与肾脏疾病相关的药物以及使用预先存在的患者合并症的健康状况代表。使用条件logistic回归模型评估肾脏疾病与PPI使用之间的相关性。即使在控制了潜在的混杂条件后，肾脏疾病与PPI使用呈正相关（比值比[OR] 1.72，95%置信区间[CI] 1.27，2.32，p < 0.001）。从研究人群中排除潜在混杂疾病状态的患者后，病例（854例中的195例）和对照（607例）的数量减少，但肾脏疾病和PPI使用之间的关系保持一致（OR 2.25，CI 1.09-4.62，p < 0.001）。诊断为肾病的患者使用PPI既往处方的可能性是其两倍。因此，医生有必要提高对患者投诉或该潜在有害事件临床表现的认识，以防止进一步损伤。
Proton pump inhibitors (PPI) are a widely-used class of drugs for the treatment of gastro-esophageal reflux disease and other acid-related disorders of the gastrointestinal tract. As a class, PPIs have demonstrated a favorable safety profile. However, case reports have suggested that this class of drugs may be linked to acute kidney injury, which may in turn lead to chronic injury or failure. The objective of this study was to determine if an association between PPIs and kidney failure exists and to estimate an effect size for the relationship between PPI use and renal disease. A nested case–control study was conducted in a privately insured population in a single Midwestern state including a total of 184,480 patients aged 18 years or older who were continuously enrolled with the insurer for at least 24 months between September 2002 and November 2005. Of the patients eligible for the study, 854 cases were identified as having at least two claims for an acute renal disease diagnosis. Cases were randomly matched with up to four controls (n = 3,289) based on age, gender, county of residence, and date of entry into the cohort. Patient demographic data, PPI use, illnesses, and medications associated with renal disease and a proxy for health status using pre-existing patient comorbidities were collected from inpatient, professional, and prescription claims data. Conditional logistic regression models were used to evaluate the association between renal disease and PPI use. Renal disease was positively associated with PPI use (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.27, 2.32, p < 0.001) even after controlling for potential confounding conditions. After removing patients with potential confounding disease states from the study population, the number of cases (195 of the 854) and controls (607) was lower, but the relationship between renal disease and PPI use remained consistent (OR 2.25, CI 1.09-4.62, p < 0.001). Patients with a renal disease diagnosis were twice as likely to have used a previous prescription for a PPI. Therefore, it is necessary for physicians to increase recognition of patient complaints or clinical manifestations of this potentially harmful event in order to prevent further injury.