Abstract：
Primary care provides an opportunity to prevent community acquired, medicine or drug-induced acute kidney injury. One of the barriers to proactive prevention of medicine-induced kidney injury in primary care is the lack of a list of nephrotoxic medicines that are most problematic in primary care, particularly one that provides a comparison of risks across medicines.
The aim of this study was to consolidate evidence on the risks associated with medicines and acute kidney injury, with a focus on medicines used in primary care.
We searched the MEDLINE and EMBASE databases to identify published studies of all medicines associated with acute kidney injury identified from spontaneous report data. For each medicine positively associated with acute kidney injury, as identified from spontaneous reports, we implemented a sequence symmetry analysis (SSA) and a case-control design to determine the association between the medicine and hospital admission with a primary diagnosis of acute kidney injury (representing community-acquired acute kidney injury). Administrative claims data held by the Australian Government Department of Veterans\' Affairs for the study period 2005-2019 were used.
We identified 89 medicines suspected of causing acute kidney injury based on spontaneous report data and a reporting odds ratio above 2, from Japan, France and the US. Spironolactone had risk estimates of 3 or more based on spontaneous reports, SSA and case-control methods, while furosemide and trimethoprim with sulfamethoxazole had risk estimates of 1.5 or more. Positive association with SSA and spontaneous reports, but not case control, showed zoledronic acid had risk estimates above 2, while candesartan telmisartan, simvastatin, naproxen and ibuprofen all had risk estimates in SSA between 1.5 and 2. Positive associations with case-control and spontaneous reports, but not SSA, were found for amphotericin B, omeprazole, metformin, amlodipine, ramipril, olmesartan, ciprofloxacin, valaciclovir, mycophenolate and diclofenac. All with the exception of metformin and omeprazole had risk estimates above 2.
This research highlights a number of medicines that may contribute to acute injury; however, we had an insufficient sample to confirm associations of some medicines. Spironolactone, furosemide, and trimethoprim with sulfamethoxazole are medicines that, in particular, need to be used carefully and monitored closely in patients in the community at risk of acute kidney injury.
The aim of this study was to consolidate evidence on the risks associated with medicines and acute kidney injury, with a focus on medicines used in primary care.
We searched the MEDLINE and EMBASE databases to identify published studies of all medicines associated with acute kidney injury identified from spontaneous report data. For each medicine positively associated with acute kidney injury, as identified from spontaneous reports, we implemented a sequence symmetry analysis (SSA) and a case-control design to determine the association between the medicine and hospital admission with a primary diagnosis of acute kidney injury (representing community-acquired acute kidney injury). Administrative claims data held by the Australian Government Department of Veterans\' Affairs for the study period 2005-2019 were used.
We identified 89 medicines suspected of causing acute kidney injury based on spontaneous report data and a reporting odds ratio above 2, from Japan, France and the US. Spironolactone had risk estimates of 3 or more based on spontaneous reports, SSA and case-control methods, while furosemide and trimethoprim with sulfamethoxazole had risk estimates of 1.5 or more. Positive association with SSA and spontaneous reports, but not case control, showed zoledronic acid had risk estimates above 2, while candesartan telmisartan, simvastatin, naproxen and ibuprofen all had risk estimates in SSA between 1.5 and 2. Positive associations with case-control and spontaneous reports, but not SSA, were found for amphotericin B, omeprazole, metformin, amlodipine, ramipril, olmesartan, ciprofloxacin, valaciclovir, mycophenolate and diclofenac. All with the exception of metformin and omeprazole had risk estimates above 2.
This research highlights a number of medicines that may contribute to acute injury; however, we had an insufficient sample to confirm associations of some medicines. Spironolactone, furosemide, and trimethoprim with sulfamethoxazole are medicines that, in particular, need to be used carefully and monitored closely in patients in the community at risk of acute kidney injury.
摘要：
初级保健提供了一个机会，以防止社区获得，药物或药物引起的急性肾损伤。在初级保健中积极预防药物引起的肾损伤的障碍之一是缺乏在初级保健中最有问题的肾毒性药物清单，特别是提供不同药物风险比较的方法。
这项研究的目的是巩固与药物和急性肾损伤相关风险的证据。重点是初级保健中使用的药物。
我们检索了MEDLINE和EMBASE数据库，以确定从自发报告数据中确定的与急性肾损伤相关的所有药物的已发表研究。对于与急性肾损伤呈正相关的每种药物，从自发报告中确定，我们实施了序列对称分析(SSA)和病例对照设计,以确定药物与入院之间的相关性,并初步诊断为急性肾损伤(代表社区获得性急性肾损伤).使用了澳大利亚政府退伍军人事务部在2005-2019年研究期间持有的行政索赔数据。
我们根据日本的自发报告数据和报告比值比高于2，确定了89种疑似引起急性肾损伤的药物。法国和美国。根据自发报告，螺内酯的风险估计为3或更多，SSA和病例控制方法，而呋塞米和甲氧苄啶联合磺胺甲恶唑的风险估计值为1.5或更高.与SSA和自发报告呈正相关，但不是病例控制，显示唑来膦酸的风险估计超过2，而坎地沙坦替米沙坦，辛伐他汀,萘普生和布洛芬在SSA中的风险估计均在1.5和2之间。与病例对照和自发报告呈正相关，但不是SSA，发现了两性霉素B,奥美拉唑,二甲双胍,氨氯地平,雷米普利,奥美沙坦,环丙沙星,伐昔洛韦,霉酚酸酯和双氯芬酸。除二甲双胍和奥美拉唑外，所有患者的风险估计值均高于2。
这项研究强调了一些可能导致急性损伤的药物；然而，我们的样本不足以证实某些药物的相关性.螺内酯,呋塞米,甲氧苄啶和磺胺甲恶唑是药物，特别是,需要谨慎使用，并密切监测社区有急性肾损伤风险的患者。
这项研究的目的是巩固与药物和急性肾损伤相关风险的证据。重点是初级保健中使用的药物。
我们检索了MEDLINE和EMBASE数据库，以确定从自发报告数据中确定的与急性肾损伤相关的所有药物的已发表研究。对于与急性肾损伤呈正相关的每种药物，从自发报告中确定，我们实施了序列对称分析(SSA)和病例对照设计,以确定药物与入院之间的相关性,并初步诊断为急性肾损伤(代表社区获得性急性肾损伤).使用了澳大利亚政府退伍军人事务部在2005-2019年研究期间持有的行政索赔数据。
我们根据日本的自发报告数据和报告比值比高于2，确定了89种疑似引起急性肾损伤的药物。法国和美国。根据自发报告，螺内酯的风险估计为3或更多，SSA和病例控制方法，而呋塞米和甲氧苄啶联合磺胺甲恶唑的风险估计值为1.5或更高.与SSA和自发报告呈正相关，但不是病例控制，显示唑来膦酸的风险估计超过2，而坎地沙坦替米沙坦，辛伐他汀,萘普生和布洛芬在SSA中的风险估计均在1.5和2之间。与病例对照和自发报告呈正相关，但不是SSA，发现了两性霉素B,奥美拉唑,二甲双胍,氨氯地平,雷米普利,奥美沙坦,环丙沙星,伐昔洛韦,霉酚酸酯和双氯芬酸。除二甲双胍和奥美拉唑外，所有患者的风险估计值均高于2。
这项研究强调了一些可能导致急性损伤的药物；然而，我们的样本不足以证实某些药物的相关性.螺内酯,呋塞米,甲氧苄啶和磺胺甲恶唑是药物，特别是,需要谨慎使用，并密切监测社区有急性肾损伤风险的患者。
