导致121例老年患者急性肾损伤的相关药物分析

Analysis of Related Drugs Leading to 121 Cases of Senile Acute Kidney Injury

目的:了解老年急性肾损伤(acute kidney injury,AKI)患者发生AKI近3个月内口服的药物,为临床预防老年AKI提供依据。方法:回顾性分析2001年1月至2020年6月于中日友好医院住院并进行肾穿刺活检确诊为AKI的老年患者的临床资料、基础病史及近3个月内口服药物情况。结果:符合入组标准的老年AKI患者共121例,其中男性患者65例(占53.7%),女性患者56例(占46.3%);中位年龄为65(62,69)岁;肾穿刺活检病理结果:急性间质性肾炎37例(占30.6%),亚急性间质性肾炎84例(占69.4%);入院时中位血肌酐水平为216.0(156.5,323.4)μmol/L。在排除了服用非甾体解热镇痛药、抗病毒药和抗菌药物等常见肾毒性药物后,患者近3个月内常用的口服药分为抗高血压药、抗糖尿病药、调节血脂药、利尿剂、中草药、抗凝血药或抗血小板药、降尿酸药、胃肠道用药及其他(如甲氨蝶呤、依帕司他等)等9类;其中,103例(占85.1%)服用抗高血压药,44例(占36.4%)服用抗糖尿病药,25例(占20.7%)服用调节血脂药,25例(占20.7%)服用利尿剂,44例(占36.4%)服用中药,20例(占16.5%)服用抗凝血药或抗血小板药,9例(占7.4%)服用降尿酸药,3例(占2.5%)服用胃肠道用药,34例(占28.1%)服用其他类药物;21例(占17.4%)服用1类药物,49例(占40.5%)同时服用2类药物,23例(占19.0%)同时服用3类药物,19例(占15.7%)同时服用4类药物,7例(占5.8%)同时服用5类药物,2例(占1.7%)同时服用6类药物,中位用药种类数为2(2,3)类。结论:老年人是药物相关AKI的高危人群,虽然服用的是常用药物,但多种常见药物联合应用有发生AKI的风险,因此用药期间应注意监测患者肾功能的变化。

OBJECTIVE:To investigate the drugs taken orally within 3 months in the elderly with acute kidney injury(AKI),so as to provide evidence for clinical prevention of AKI in the elderly.METHODS:The clinical data,basic medical history and oral medication in recent 3 months of the elderly diagnosed with AKI who underwent renal needle biopsy in China-Japan Friendship Hospital from Jan.2001 to Jun.2020 were retrospectively analyzed.RESULTS:A total of 121 elderly patients with AKI met the inclusion criteria,including 65 male patients(53.7%)and 56 female patients(46.3%).The median age was 65(62,69)years old.The pathological results of renal needle biopsy were acute interstitial nephritis in 37 cases(30.6%)and subacute interstitial nephritis in 84 cases(69.4%).The median serum creatinine level was 216.0(156.5,323.4)μmol/L at admission.After excluding the use of common nephrotoxic drugs such as non-steroid anti-inflammatory,antiviral drugs and antibiotics,the commonly used oral drugs were divided into antihypertensive drugs,hypoglycemic drugs,lipid-lowering drugs,diuretics,Chinese herbal medicines,anticoagulants or platelet aggregation inhibitors,uric acid-lowering drugs,gastrointestinal drugs and others(methotrexate and epalrestat).There were 103 cases(85.1%)treated with antihypertensive drugs,44 cases(36.4%)with hypoglycemic drugs,25 cases(20.7%)with lipid-lowering drugs,25 cases(20.7%)with diuretics,44 cases(36.4%)with traditional Chinese medicine,20 cases(16.5%)with anticoagulant or platelet aggregation inhibitors,9 cases(7.4%)with uric acid-lowering drugs and 3 cases(2.5%)with gastrointestinal drugs,and 34 cases(28.1%)with other drugs.According to the number of types of drugs taken at the same time,there were 21 cases(17.4%)took one type of drug,49 cases(40.5%)took two types of drugs,23 cases(19.0%)took three types of drugs,19 cases(15.7%)took four types of drugs,7 cases(5.8%)took five types of drugs and 2 cases(1.7%)took six types of drugs,the median of medication was 2(2,3).CONCLUSIONS:The elderly are at high risk of drug-related AKI.Although they are taking common drugs,the drug combination of multiple common drugs has the risk of AKI.Therefore,during the medication period,attention should be paid to monitoring the changes in the patients’renal function.