背景:替考拉宁(TEIC)是一种肾毒性剂。然而,关于合并用药对肾毒性的影响知之甚少。在这项研究中,我们研究了合并用药对肾毒性的影响.
方法:对在东京牙科学院开始TEIC的患者(≥18岁)进行了回顾性观察性病例对照研究,市川总医院,2013年1月至2023年4月。主要结果是肾毒性,定义为血清肌酐水平从基线增加≥50%或≥0.5mg/dL。采用Logistic回归分析确定TEIC相关肾毒性的危险因素。此外,我们研究了肾毒性与预测的游离TEIC浓度之间的关系.
结果:在305名患者中,43(14.1%)出现肾毒性。多变量逻辑回归分析确定血清白蛋白(比值比[OR]=0.50,95%置信区间[CI]0.27-0.89,p=0.02),合并使用loop利尿剂(OR=2.22,95%CI1.10-4.59,p=0.03),抗病毒药物(OR=3.24,95%CI1.32-7.62,p<0.01),和血管升压药(OR=2.57,95%CI1.10-5.78,p=0.03)是TEIC患者肾毒性的相关危险因素。在216名患者中,预测TEIC浓度为3.6[四分位数间距(IQR),肾毒性组的2.6-4.9μg/mL与3.6[IQR,非肾毒性组2.5-4.7]μg/mL,差异无统计学意义(p=0.69)。
结论:我们的研究结果表明,改变环状利尿剂的伴随使用的重要性,抗病毒药物,和血管加压药。
BACKGROUND: Teicoplanin (TEIC) is a nephrotoxic agent. However, little is known about the effects of concomitant medications on nephrotoxicity. In this study, we investigated the effects of concomitant drugs on nephrotoxicity.
METHODS: A retrospective observational case-control study was conducted on patients (≥18 years) who started TEIC at the Tokyo Dental College, Ichikawa General Hospital, between January 2013 and April 2023. The primary outcome was nephrotoxicity, defined as an increase in serum creatinine levels of ≥50 % or ≥0.5 mg/dL from baseline. Logistic regression analysis was used to determine the risk factors for nephrotoxicity associated with TEIC. In addition, we investigated the relationship between nephrotoxicity and predicted free TEIC concentrations.
RESULTS: Of 305 patients, 43 (14.1 %) developed nephrotoxicity. The multivariate logistic regression analysis identified that serum albumin (odds ratio [OR] = 0.50, 95 % confidence interval [CI] 0.27-0.89, p = 0.02), concomitant use of loop diuretics (OR = 2.22, 95 % CI 1.10-4.59, p = 0.03), antivirals (OR = 3.24, 95 % CI 1.32-7.62, p < 0.01), and vasopressors (OR = 2.57, 95 % CI 1.10-5.78, p = 0.03) were the associated risk factors for nephrotoxicity in patients administered with TEIC. In 216 patients, predicted TEIC concentrations were 3.6 [interquartile range (IQR), 2.6-4.9] μg/mL in the nephrotoxicity group versus 3.6 [IQR, 2.5-4.7] μg/mL in the non-nephrotoxicity group, with no significant difference (p = 0.69).
CONCLUSIONS: Our results indicate the importance of modifying the concomitant use of loop diuretics, antivirals, and vasopressors.