ACUTE RENAL INSUFFICIENCY AND NSAIDS

急性肾功能不全是老年人的一种毁灭性疾病 据报道，存活至出院的比例为约30 - 55%。 即便对于少数 那些没有预先存在的肾脏疾病，有一些人会 随后需要长期透析。 其中， 潜在的慢性肾功能不全，对肾脏的急性损伤 可能会加速需要肾脏替代的进展 疗法 在一九八八年，65岁及以上人士约占15万人的27 医疗保险的终末期肾病计划中的患者，几乎所有人都是 慢性透析，医疗保险费用约为32，000美元， 人每年。 老年人群中常见的几种临床疾病 包括充血性心力衰竭、肝硬化和肾功能不全 需要局部合成洋地黄素以维持肾灌注。 大量的实验研究表明， 患有这些疾病的患者将遭受肾功能恶化， 当暴露于任何一种非甾体抗- 抗炎药（NSAIDS）。 患有这些疾病的患者 当他们服用NSAIDs时， 这些药物抑制前列腺素的产生。 NSAID是老年人群中的常见暴露，约13%的老年人使用NSAID。 在任何给定的时间，处方NSAID，并接近40%得到至少 一年内只开一个处方 尽管高风险暴露于 这些药物及其已知的对肾功能的急性有害作用， 关于这些药物对临床显著的 老年人的肾脏疾病 因此，我们建议进行一项回顾性队列研究， 急性肾功能衰竭住院的发生率 参加田纳西州医疗补助计划的65岁及以上的人 从1987年到1991年的计划;（大约 83，000）;急性肾功能不全住院的发生率 在目前使用处方NSAID的同一人群中; 急性肾功能不全的相对和归因风险 与非甾体抗炎药处方药的使用有关。

Acute renal insufficiency is a devastating illness in elderly persons with a survival to discharge reported to be about 30 to 55%. Even among those with no-pre-existing renal disease, there are some who will subsequently require chronic dialysis. Among those persons with underlying chronic renal insufficiency, an acute insult to the kidneys may accelerate the progression toward the need for renal replacement therapy. In 1988, persons 65 and over comprised about 27% of the 150,000 patients in Medicare's End Renal Disease program, almost all of whom were on chronic dialysis at a cost to Medicare of approximately $32,000 per person per year. Several clinical conditions which are common in elderly populations including congestive heart failure, cirrhosis, and renal insufficiency require local synthesis of prostaglandins to maintain renal perfusion.. Numerous experimental studies have shown that a large proportion of patients with these conditions will suffer deterioration in renal function when exposed to any of a variety of nonsteroidal anti- inflammatory drugs (NSAIDS). Patients with these disorders are at risk from acute ischemic injury to the kidney when they take NSAIDs because these drugs inhibit prostaglandin production. NSAIDs are a common exposure in elderly populations, with about 13% on prescriptions NSAIDs at any given time, and close to 40% getting at least one prescription during a year's time. Despite the high exposure to these drugs and their known acute detrimental effects on renal function, little is known about the impact of these drugs on clinically significant renal disease in the elderly. We therefor propose to conduct a retrospective cohort study to estimate the incidence of hospitalization for acute renal failure among all persons aged 65 years and older enrolled in the Tennessee Medicaid program from 1987 through 1991; (point prevalence enrollment of about 83,000); the incidence of hospitalization for acute renal insufficiency among this same population who are current users of prescription NSAIDs; and the relative and attributable risks for acute renal insufficiency associated with prescription NSAIDs use in this population.