Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study.
Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study.
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DOI：
10.9778/cmajo.20140074
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发表时间：
2015-04-01
期刊：
影响因子：
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通讯作者：
Juurlink, David N
中科院分区：
文献类型：
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作者：
Antoniou, Tony;Macdonald, Erin M;Juurlink, David N
背景：质子泵抑制剂（PPIs）引起间质性肾炎，是急性肾损伤的一个未被充分认识的原因。我们检查了大量接受PPIs的老年患者发生急性肾损伤和急性间质性肾炎的风险。方法：我们进行了一项基于人群的研究，纳入了2002年4月1日至2011年11月30日期间开始接受PPI治疗的安大略省66岁及以上居民。我们使用倾向评分匹配来建立一个高度可比的对照患者参照组。主要结局是120天内因急性肾损伤住院，次要分析是急性间质性肾炎。我们使用Cox比例风险回归来调整组间差异。结果：我们研究了290592名接受PPI治疗的个体和相同数量的匹配对照。急性肾损伤发生率（分别为13.49 vs 5.46 / 1000人-年；风险比[HR] 2.52, 95% CI 2.27 ~ 2.79）和急性间质性肾炎发生率（0.32 vs 0.11 / 1000人-年；HR 3.00, 95% CI 1.47 ~ 6.14）均高于对照组。解释：在我们的老年人研究人群中，那些开始PPI治疗的人有急性肾损伤和急性间质性肾炎的风险增加。这些都是可能可逆的情况，可能不容易归因于药物治疗。临床医生应认识到PPIs治疗期间急性间质性肾炎的风险，适当监测患者，并劝阻滥用这些药物。
BACKGROUND: Proton pump inhibitors (PPIs) cause interstitial nephritis and are an underappreciated cause of acute kidney injury. We examined the risk of acute kidney injury and acute interstitial nephritis in a large population of older patients receiving PPIs.METHODS: We conducted a population-based study involving Ontario residents aged 66 years and older who initiated PPI therapy between Apr. 1, 2002, and Nov. 30, 2011. We used propensity score matching to establish a highly comparable reference group of control patients. The primary outcome was hospital admission with acute kidney injury within 120 days, and a secondary analysis examined acute interstitial nephritis. We used Cox proportional hazards regression to adjust for differences between groups.RESULTS: We studied 290592 individuals who commenced PPI therapy and an equal number of matched controls. The rates of acute kidney injury (13.49 v. 5.46 per 1000 person-years, respectively; hazard ratio [HR] 2.52, 95% CI 2.27 to 2.79) and acute interstitial nephritis (0.32 vs. 0.11 per 1000 person-years; HR 3.00, 95% CI 1.47 to 6.14) were higher among patients given PPIs than among controls.INTERPRETATION: In our study population of older adults, those who started PPI therapy had an increased risk of acute kidney injury and acute interstitial nephritis. These are potentially reversible conditions that may not be readily attributed to drug treatment. Clinicians should appreciate the risk of acute interstitial nephritis during treatment with PPIs, monitor patients appropriately and discourage the indiscriminate use of these drugs.