Selective and non-selective non-steroidal anti-inflammatory drugs and the risk of acute kidney injury
Selective and non-selective non-steroidal anti-inflammatory drugs and the risk of acute kidney injury
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DOI：
10.1002/pds.1798
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发表时间：
2009-10-01
影响因子：
2.6
通讯作者：
Miller, Donald R.
中科院分区：
文献类型：
--
作者：
Lafrance, Jean-Philippe;Miller, Donald R.
目的 使用非甾体类抗炎药 (NSAID) 与急性肾损伤 (AKI) 的风险相关。 AKI 的风险可能因 NSAID 的选择性而异，但尚未在直接根据实验室数据评估 AKI 的大型队列中进行研究。目的是使用基于实验室的 AKI 定义来比较选择性和非选择性 NSAID 之间的 AKI 风险。 方法 我们在美国退伍军人事务部医疗保健系统中进行了一项回顾性巢式病例对照研究。从 1459 271 名新 NSAID 使用者的队列中，我们确定了 22 824 例 AKI 病例（97% 为男性；平均年龄：63 岁），以及 2000 年至 2006 年间的 336 734 例匹配对照。AKI 被定义为肌酐增加超过 50%。 结果 我们发现任何单一 NSAID 的新使用者发生 AKI 的风险较高（调整后的比值比 = 1.82；95%CI：1.68，1.98）与最近没有使用过的非用户相比。不同非甾体抗炎药的 AKI 风险不同，风险通常随着选择性的降低而增加：罗非考昔 (0.95; 0.64, 1.42)、塞来昔布 (0.96; 0.63, 1.47)、美洛昔康 (1.13; 0.63, 2.05)、依托度酸 (1.31; 1.08, 1.59)、双氯芬酸(1.11；0.84，1.48)，吡罗昔康(1.53；1.05，2.23)，水杨酸(1.51；1.22，1.87)，舒林酸(1.61；1.12，2.30)，布洛芬(2.25，2.04，2.49)，萘普生（1.72；1.52，1.95），高剂量阿司匹林（3.64；2.46，5.37），吲哚美辛（1.94；1.56，2.42），酮咯酸（2.07；1.78，2.41）。使用多种 NSAID 的患者似乎具有更高的风险 (2.90; 2.62, 3.22)。 结论 这项研究提供的证据表明，与萘普生或其他非选择性 NSAID 相比，更多选择性药物的 AKI 风险可能更低。版权所有 (C) 2009 John Wiley & Sons, Ltd.
Purpose Use of non-steroidal anti-inflammatory drugs (NSAID) is associated with risk of acute kidney injury (AKI). Risk of AKI may vary with selectivity of the NSAID, but this has not been studied in a large cohort where AKI was assessed directly from laboratory data. The objective was to compare AKI risk between selective and non-selective NSAIDs using a laboratory-based definition of AKI.Methods We conducted a retrospective nested case-control study in the U.S. Department of Veterans Affairs health care system. From a cohort of 1459 271 new NSAID users, we identified 22 824 cases of AKI (97% male; mean age: 63 years), and 336 734 matched controls between 2000 and 2006. AKI was defined as a creatinine increase of greater than 50%.Results We found higher risk of AKI in new users of any single NSAID (adjusted odds ratio = 1.82; 95%CI: 1.68, 1.98) compared to non-users without recent use. The risk of AKI varied among different NSAIDs with risk generally increasing with decrease in selectivity: rofecoxib (0.95; 0.64, 1.42), celecoxib (0.96; 0.63, 1.47), meloxicam (1.13; 0.63, 2.05), etodolac (1.31; 1.08, 1.59), diclofenac (1.11; 0.84, 1.48), piroxicam (1.53; 1.05, 2.23), salsalate (1.51; 1.22, 1.87), sulindac (1.61; 1.12, 2.30), ibuprofen (2.25, 2.04, 2.49), naproxen (1.72; 1.52, 1.95), high dose aspirin (3.64; 2.46, 5.37), indomethacin (1.94; 1.56, 2.42), keterolac (2.07; 1.78, 2.41). Those using multiple NSAIDs appeared to have higher risk (2.90; 2.62, 3.22).Conclusions This study provides evidence that risk of AKI may be lower with more selective agents than with naproxen or other nonselective NSAIDs. Copyright (C) 2009 John Wiley & Sons, Ltd.