Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis.
Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis.
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DOI：
10.1186/s12882-017-0673-8
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发表时间：
2017-08-01
期刊：
影响因子：
2.3
通讯作者：
Guthrie B
中科院分区：
文献类型：
--
作者：
Zhang X;Donnan PT;Bell S;Guthrie B
非类固醇抗炎药(NSAIDs)是不良药物事件(ADE)的常见原因，但NSAIDs的肾脏风险不如胃肠道和心脏风险量化得好。本文系统地回顾了已发表的基于人群的观察性研究，考察了社区成年人和既往慢性肾脏疾病(CKD)患者与非类固醇抗炎药相关的急性肾损伤(AKI)的风险。搜索Medline和EMBASE数据库，直到2016年6月，筛选了3789篇论文。在随机效应荟萃分析中，有10项研究报告了普通人群中AKI的非甾体类抗炎药风险，其中5项研究还报告了慢性肾脏病患者中的非类固醇抗炎药风险。在普通人群中，AKI与当前NSAID暴露的合并优势比(OR)为1.73(95%可信区间1.44比2.07)，在老年人中观察到的风险略高(OR 2.51，95%可信区间1.52比2.68)。在CKD患者中，因当前非甾体抗炎药暴露而导致AKI的个体研究OR范围为1.12至5.25，合并估计OR为1.63(95%可信区间为1.22至2.19)。没有研究报告不同人群中AKI的基线风险，这意味着无法估计绝对风险，但CKD患者和老年人的基线风险和非类固醇抗炎药暴露的绝对风险可能更高。为了更好地为临床决策提供信息，需要大量基于人群的研究，使用当前的定义来衡量AKI，并估计伤害的绝对风险。本文的在线版本(doi：10.1186/s12882-0170673-8)包含补充材料，授权用户可以使用。
Non-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of adverse drug events (ADEs), but renal risks of NSAIDs are less well quantified than gastrointestinal and cardiac risks. This paper reports a systematic review of published population-based observational studies examining the risk of acute kidney injury (AKI) associated with NSAIDs in community-dwelling adults and those with pre-existing chronic kidney disease (CKD). MEDLINE and EMBASE databases were searched until June 2016, and 3789 papers screened. Ten studies reporting NSAID risk of AKI in the general population were included in random effects meta-analysis, of which five additionally reported NSAID risk in people with CKD. In the general population, the pooled odds ratio (OR) of AKI for current NSAID exposure was 1.73 (95%CI 1.44 to 2.07), with somewhat higher risk observed in older people (OR 2.51, 95%CI 1.52 to 2.68). In people with CKD, individual study OR of AKI due to current NSAID exposure ranged from 1.12 to 5.25, with pooled estimate OR 1.63 (95% CI 1.22 to 2.19). No study reported baseline risk of AKI in different populations meaning absolute risks could not be estimated, but baseline risk and therefore the absolute risk of NSAID exposure is likely to be higher in people with CKD and older people. Large population based studies measuring AKI using current definitions and estimating the absolute risk of harm are needed in order to better inform clinical decision making. The online version of this article (doi:10.1186/s12882-017-0673-8) contains supplementary material, which is available to authorized users.
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