Incidence and risk factors of acute kidney injury in patients with polypharmacy: a systematic review and meta-analysis.

IF 3.2 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Fengxue Yang, Linfang Zhu, Bing Cao, Hongli Miao, Li Zeng, Zhongqing Yuan, Yi Tian, Yuanting Li
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引用次数: 0

Abstract

Introduction: Polypharmacy, typically defined as the use of five or more medications, has become increasingly common among older adults due to the rising prevalence of multimorbidity. While polypharmacy can be clinically necessary, it poses substantial risks for adverse drug events, including acute kidney injury (AKI). Drug-induced AKI accounts for a significant proportion of hospital-acquired cases and can result in prolonged hospitalization, increased healthcare costs, and higher mortality. Despite growing concern over these risks, the incidence of AKI associated with polypharmacy and the specific clinical and pharmacological factors contributing to this risk remain poorly quantified across different populations and setting.

Aim: To estimate the incidence of AKI among adults exposed to polypharmacy and identify key drug-related and clinical risk factors.

Method: A systematic review and meta-analysis were conducted and reported following PRISMA guidelines. We searched eight international and Chinese databases from inception to April 2025 for observational studies involving adults (≥ 18 years) receiving polypharmacy that reported AKI incidence or related risk factors. Eligible studies were assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was used to calculate pooled AKI incidence. A narrative synthesis summarized the definitions of polypharmacy and identified associated risk factors.

Results: Ten studies comprising over 302,000 participants were included; six studies provided data suitable for meta-analysis. The pooled incidence of AKI among patients exposed to polypharmacy was 18% (95% CI 2%, 45%). Key risk factors included high medication burden (≥ 5 or ≥ 10 medications), cardiovascular drug combinations, use of nephrotoxic agents, pre-existing renal impairment, frailty, and exposure to intensive care. Definitions of polypharmacy varied substantially across studies, including count-based thresholds, class-specific definitions, and risk-based exposure models.

Conclusion: Polypharmacy is significantly associated with an increased incidence of AKI, particularly among hospitalized and clinically vulnerable individuals. The lack of standardized definitions for polypharmacy complicates evidence synthesis and cross-study comparisons. Standardized terminology and risk-adjusted prescribing practices are essential to improve medication safety and renal outcomes in at-risk populations.

多药患者急性肾损伤的发生率和危险因素:系统回顾和荟萃分析。
多种用药,通常定义为使用五种或五种以上的药物,由于多种疾病的患病率上升,在老年人中变得越来越普遍。虽然多种用药在临床上是必要的,但它会带来药物不良事件的重大风险,包括急性肾损伤(AKI)。药物性AKI在医院获得性病例中占很大比例,可导致住院时间延长、医疗费用增加和死亡率升高。尽管对这些风险的关注越来越多,但在不同的人群和环境中,与多种药物相关的AKI发生率以及导致这种风险的特定临床和药理学因素仍然缺乏量化。目的:估计暴露于多种药物的成人AKI的发生率,并确定关键的药物相关和临床危险因素。方法:根据PRISMA指南进行系统回顾和荟萃分析。从成立到2025年4月,我们检索了8个国际和中国数据库,检索了涉及成人(≥18岁)的观察性研究,这些研究报告了AKI发病率或相关危险因素。采用纽卡斯尔-渥太华量表对符合条件的研究进行评估。随机效应荟萃分析用于计算合并AKI发生率。叙述性综合总结了多种药物的定义,并确定了相关的危险因素。结果:纳入了10项研究,超过302,000名参与者;6项研究提供了适合meta分析的数据。暴露于多种药物的患者AKI的总发生率为18% (95% CI 2%, 45%)。主要危险因素包括高用药负担(≥5或≥10种药物)、心血管药物联合用药、使用肾毒性药物、既往肾损害、虚弱和接受重症监护。多种药物的定义在不同的研究中有很大的不同,包括基于计数的阈值、特定类别的定义和基于风险的暴露模型。结论:多药治疗与AKI发生率增加显著相关,特别是在住院和临床易感人群中。缺乏标准的多药定义使证据合成和交叉研究比较复杂化。标准化术语和经风险调整的处方做法对于改善高危人群的用药安全性和肾脏预后至关重要。
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来源期刊
CiteScore
4.10
自引率
8.30%
发文量
131
审稿时长
4-8 weeks
期刊介绍: The International Journal of Clinical Pharmacy (IJCP) offers a platform for articles on research in Clinical Pharmacy, Pharmaceutical Care and related practice-oriented subjects in the pharmaceutical sciences. IJCP is a bi-monthly, international, peer-reviewed journal that publishes original research data, new ideas and discussions on pharmacotherapy and outcome research, clinical pharmacy, pharmacoepidemiology, pharmacoeconomics, the clinical use of medicines, medical devices and laboratory tests, information on medicines and medical devices information, pharmacy services research, medication management, other clinical aspects of pharmacy. IJCP publishes original Research articles, Review articles , Short research reports, Commentaries, book reviews, and Letters to the Editor. International Journal of Clinical Pharmacy is affiliated with the European Society of Clinical Pharmacy (ESCP). ESCP promotes practice and research in Clinical Pharmacy, especially in Europe. The general aim of the society is to advance education, practice and research in Clinical Pharmacy . Until 2010 the journal was called Pharmacy World & Science.
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