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，出院存活率约为30%至55%。即使是在 那些没有既往肾脏疾病的人，有些人会 随后需要进行慢性透析。在那些有 慢性肾功能不全是对肾脏的一种急性侮辱 可能加速向需要肾脏替代的方向发展 心理治疗。在1988年，65岁及以上的人约占15万人的27% 参加联邦医疗保险终止肾脏疾病计划的患者，几乎所有人都是 慢性透析，每项医疗保险费用约为32,000美元 每年一个人。 老年人常见的几种临床情况 包括充血性心力衰竭、肝硬变和肾功能不全 需要局部合成前列腺素以维持肾脏的血流灌注。 大量的实验研究表明，很大比例的 患有这些疾病的患者将遭受肾脏的恶化。 当接触到任何一种非类固醇抗病毒药物时 炎症性药物(非甾体抗炎药)。患有这些疾病的患者处于危险之中 当他们服用非类固醇抗炎药时，肾脏会受到急性缺血性损伤，因为 这些药物抑制前列腺素的产生。 非甾体抗炎药在老年人群中是一种常见的暴露，约有13%的人 在任何给定的时间开出非甾体抗炎药的处方，近40%的人至少得到 一年内的一张处方。尽管大量接触到 这些药物及其已知的对肾功能的急性有害影响， 关于这些药物对临床意义的影响，我们知之甚少 老年人的肾脏疾病。 因此，我们建议进行一项回溯性队列研究，以估计 急性肾功能衰竭的住院率 65岁及以上的人参加田纳西州的医疗补助 计划从1987年到1991年；(参加人数约为 83,000人)；因急性肾功能不全住院的发生率 在目前使用非甾体抗炎药处方药的同一人群中； 以及急性肾功能不全的相对和归属风险 与处方类非类固醇抗炎药在该人群中的使用有关。

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.