非甾体抗炎药与糖尿病和糖尿病肾病急性不良肾脏结局的风险

Pub Date : 2022-01-01 DOI:10.3233/JRS-200096

Cynthia Ciwei Lim, Hanis Bte Abdul Kadir, Ngiap Chuan Tan, Andrew Teck Wee Ang, Yong Mong Bee, Puay Hoon Lee, Bandy Qiuling Goh, Alcey Li Chang Ang, Xiaohui Xin, Jia Liang Kwek, Amanda Yun Rui Lam, Jason Chon Jun Choo

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引用次数: 1

摘要

背景:糖尿病(DM)患者可能容易发生非甾体抗炎药(NSAID)诱导的急性肾损伤(AKI)，但有关非甾体抗炎药相关的肾脏不良事件的数据很少。目的:我们旨在评估糖尿病和糖尿病性慢性肾脏疾病(CKD)患者全身性非甾体抗炎药(NSAID)后急性肾损伤和/或高钾血症的风险。方法:回顾性队列研究2015年7月至2017年12月来自新加坡总医院和新加坡卫生综合诊所的3896名成人糖尿病患者的事件处方。从电子病历中检索实验室、住院和用药数据。主要终点是处方后30天内AKI和/或高钾血症的发生率。结果:AKI和/或高钾血症发生在13.5%的DM和15.8%的糖尿病性CKD中。非选择性糖尿病患者(调整or 1.62, 95% CI 0.99-2.65, p = 0.05)和糖尿病性CKD患者(调整or 0.64, 95% CI 0.15-2.82, p = 0.64)，全体性非甾体抗炎药>14天与30天AKI和/或高钾血症风险之间的相关性未达到统计学意义，但当非甾体抗炎药与肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂联合使用时，AKI和/或高钾血症的发生率显著增加(调整or 4.17, 95% CI 1.74-9.98，p = 0.001)或利尿剂(调整后的or为3.31,95% CI为1.09-10.08,p = 0.04)和无糖尿病性CKD(调整后的or为1.98,95% CI为1.16-3.36,p = 0.01)。结论:非甾体抗炎药处方>14天的糖尿病患者同时服用RAAS阻滞剂或利尿剂，其30天AKI和/或高钾血症的风险较高。

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Non-steroidal anti-inflammatory drugs and risk of acute adverse renal outcomes in diabetes and diabetic kidney disease.

Background: Individuals with diabetes mellitus (DM) may be susceptible to non-steroidal anti-inflammatory drug (NSAID)-induced acute kidney injury (AKI) but data on NSAID-related adverse renal events is sparse.

Objective: We aimed to evaluate the risk of acute kidney injury and/or hyperkalemia after systemic NSAID among individuals with DM and diabetic chronic kidney disease (CKD).

Methods: Retrospective cohort study of 3896 adults with DM with incident prescriptions between July 2015 and December 2017 from Singapore General Hospital and SingHealth Polyclinics. Laboratory, hospitalization and medication data were retrieved from electronic medical records. The primary outcome was the incidence of AKI and/ or hyperkalemia within 30 days after prescription.

Results: AKI and/or hyperkalemia occurred in 13.5% of all DM and 15.8% of diabetic CKD. The association between systemic NSAID >14 days and 30-day risk of AKI and/or hyperkalemia failed to reach statistical significance in unselected DM (adjusted OR 1.62, 95% CI 0.99-2.65, p = 0.05) and diabetic CKD (adjusted OR 0.64, 95% CI 0.15-2.82, p = 0.64), but the odds of AKI and/or hyperkalemia were markedly and significantly increased when NSAID was prescribed with renin-angiotensin-aldosterone system (RAAS) blocker (adjusted OR 4.17, 95% CI 1.74-9.98, p = 0.001) or diuretic (adjusted OR 3.31, 95% CI 1.09-10.08, p = 0.04) and in the absence of diabetic CKD (adjusted OR 1.98, 95% CI 1.16-3.36, p = 0.01).

Conclusion: NSAID prescription >14 days in individuals with DM with concurrent RAAS blockers or diuretics was associated with higher 30-day risk of AKI and/or hyperkalemia.

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