Association between gastroprotective agents and acute kidney injury in patients receiving non-steroidal anti-inflammatory drugs: Analysis of a Japanese hospital-based database.
acute kidney injury
histamine‐2 receptor antagonist
misoprostol
non‐steroidal anti‐inflammatory drug
proton pump inhibitor
Journal
Pharmacotherapy
ISSN: 1875-9114
Titre abrégé: Pharmacotherapy
Pays: United States
ID NLM: 8111305
Informations de publication
Date de publication:
14 Oct 2024
14 Oct 2024
Historique:
revised:
09
09
2024
received:
15
01
2024
accepted:
19
09
2024
medline:
14
10
2024
pubmed:
14
10
2024
entrez:
14
10
2024
Statut:
aheadofprint
Résumé
The concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) potentially increases the risk of acute kidney injury (AKI). However, the risk of AKI has not been comprehensively assessed for the concomitant use of NSAIDs with gastroprotective agents such as misoprostol and PPIs. The objective of this study was to evaluate whether the use of various gastroprotective agents affects the risk of AKI in patients receiving NSAIDs. The data analyzed were obtained from the JMDC hospital-based administrative claims database between April 2014 and August 2022. Histamine-2 receptor antagonists (H2RAs) were compared with PPIs or misoprostol in patients receiving NSAIDs. The primary outcome was the incidence of AKI. The covariates considered were age and sex, admission to intensive care unit, presence of comorbidities based on the modified Charlson Comorbidity Index, and use of renin-angiotensin system inhibitors, loop diuretics, other diuretics, and lithium. AKI was identified by changes in serum creatinine. The distribution of AKI was analyzed using the log-rank test, and estimates of the incidence of AKI were compared among the groups using a Cox proportional hazards model with time-varying variables. Models were adjusted using a doubly robust method that accounts for the inverse probability of treatment weighting at baseline while adjusting for covariates. After screening, 11,688 patients were eligible for inclusion (1729 for H2RAs, 368 for misoprostol, and 9591 for PPIs). AKI occurred in 0.5% of H2RA recipients and 1.1% of PPI recipients; no AKI was observed in the misoprostol group. Compared with H2RAs, the risk of AKI tended to be higher with PPIs (adjusted hazard ratio 1.83, 95% confidence interval 0.92-3.63, p = 0.08). Compared with H2RAs, PPIs may increase the risk of AKI in patients receiving NSAIDs, although no statistically significant difference was observed. Further research is required to assess the risk trade-off with consideration of both peptic ulcer prevention and the increased risk of AKI in patients concurrently treated with NSAIDs and H2RAs, misoprostol, or PPIs.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Japan Science and Technology Agency
Informations de copyright
© 2024 The Author(s). Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc.
Références
Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15 Suppl 3(Suppl 3):S2.
Vardy J, Agar M. Nonopioid drugs in the treatment of cancer pain. J Clin Oncol. 2014;32(16):1677‐1690.
Gupta A, Bah M. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep. 2016;20(11):1‐14.
Zhou Y, Boudreau DM, Freedman AN. Trends in the use of aspirin and nonsteroidal anti‐inflammatory drugs in the general U.S. population. Pharmacoepidemiol Drug Saf. 2014;23(1):43‐50.
Zhang X, Donnan PT, Bell S, Guthrie B. 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. BMC Nephrol. 2017;18(1):256.
Anwar A, John Anwar I, Delafontaine P. Elevation of cardiovascular risk by non‐steroidal anti‐inflammatory drugs. Trends Cardiovasc Med. 2015;25(8):726‐735.
Peng S, Duggan A. Gastrointestinal adverse effects of non‐steroidal anti‐inflammatory drugs. Expert Opin Drug Saf. 2005;4(2):157‐169.
Lanza FL, Chan FKL, Quigley EMM, et al. Guidelines for prevention of NSAID‐related ulcer complications. Am J Gastroenterol. 2009;104(3):728‐738.
Joo MK, Park CH, Kim JS, et al. Clinical guidelines for drug‐related peptic ulcer, 2020 revised edition. Gut Liver. 2020;14(6):707‐726.
Rostom A, Wells G, Tugwell P, Welch V, Dube C, McGowan J. Prevention of chronic NSAID induced upper gastrointestinal toxicity. Cochrane Database Syst Rev. 2000;2011(3):CD002296.
Leonard CE, Freeman CP, Newcomb CW, et al. Proton pump inhibitors and traditional nonsteroidal anti‐inflammatory drugs and the risk of acute interstitial nephritis and acute kidney injury. Pharmacoepidemiol Drug Saf. 2012;21(11):1155‐1172.
Ikuta K, Nakagawa S, Momo K, et al. Association of proton pump inhibitors and concomitant drugs with risk of acute kidney injury: a nested case‐control study. BMJ Open. 2021;11(2):e041543.
Munger MA, Nelson SD, Teng CC, Cheung AK, Sauer BC. Reduced risk of NSAID‐induced adverse events with concomitant use of misoprostol (MICRO study). Pharmacotherapy. 2022;42(7):540‐548.
Mitsuboshi S, Kotake K, Takahashi T, Sato K, Sakamaki T. Association between misoprostol and nonsteroidal anti‐inflammatory drug‐induced kidney injury: a systematic review and meta‐analysis. Br J Clin Pharmacol. 2023;89(9):2662‐2670.
Laurent T, Simeone J, Kuwatsuru R, et al. Context and considerations for use of two Japanese real‐world databases in Japan: medical data vision and Japanese medical data center. Drugs‐Real World Outcomes. 2022;9(2):175‐187.
Nagai K, Tanaka T, Kodaira N, Kimura S, Takahashi Y, Nakayama T. Data resource profile: JMDC claims databases sourced from medical institutions. J Gen Fam Med. 2020;21(6):211‐218.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453‐1457.
Kellum JA, Lameire N, Aspelin P, et al. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care. 2013;17(1):204.
Valkhoff VE, Coloma PM, Masclee GMC, et al. Validation study in four health‐care databases: upper gastrointestinal bleeding misclassification affects precision but not magnitude of drug‐related upper gastrointestinal bleeding risk. J Clin Epidemiol. 2014;67(8):921‐931.
Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676‐682.
Lakatos E. Sample sizes based on the log‐rank statistic in complex clinical trials. Biometrics. 1988;44(1):229‐241.
Jeon N, Park H, Segal R, Brumback B, Winterstein AG. Non‐steroidal anti‐inflammatory drug‐associated acute kidney injury: does short‐term NSAID use pose a risk in hospitalized patients? Eur J Clin Pharmacol. 2021;77(9):1409‐1417.
Nash DM, Markle‐Reid M, Brimble KS, et al. Nonsteroidal anti‐inflammatory drug use and risk of acute kidney injury and hyperkalemia in older adults: a population‐based study. Nephrol Dial Transplant. 2019;34(7):1145‐1154.
Yang M, He M, Zhao M, et al. Proton pump inhibitors for preventing non‐steroidal anti‐inflammatory drug induced gastrointestinal toxicity: a systematic review. Curr Med Res Opin. 2017;33(6):973‐980.
Lanas A. Economic analysis of strategies in the prevention of non‐steroidal anti‐inflammatory drug‐induced complications in the gastrointestinal tract. Aliment Pharmacol Ther. 2004;20(3):321‐331.
Baker M, Perazella MA. NSAIDs in CKD: are they safe? Am J Kidney Dis. 2020;76(4):546‐557.
Ungprasert P, Cheungpasitporn W, Crowson CS, Matteson EL. Individual non‐steroidal anti‐inflammatory drugs and risk of acute kidney injury: a systematic review and meta‐analysis of observational studies. Eur J Intern Med. 2015;26(4):285‐291.
Edinoff AN, Wu NW, Parker K, et al. Proton pump inhibitors, kidney damage, and mortality: an updated narrative review. Adv Ther. 2023;40(6):2693‐2709.
Levey AS, James MT. Acute kidney injury. Ann Intern Med. 2017;167(9):ITC66‐ITC80.
Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sørensen HT. The predictive value of ICD‐10 diagnostic coding used to assess Charlson comorbidity index conditions in the population‐based Danish National Registry of patients. BMC Med Res Methodol. 2011;11(1):1‐6.
Wainstein M, MacDonald S, Fryer D, et al. Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID‐19: a multinational study using the ISARIC‐WHO clinical characterisation protocol. PLoS Med. 2022;19(4):e1003969.