Analgesic use and associated adverse events in patients with chronic kidney disease: a systematic review and meta-analysis

医学 止痛药 不利影响 荟萃分析 肾脏疾病 人口 内科学 背景(考古学) 置信区间 重症监护医学 麻醉 环境卫生 生物 古生物学
作者
Emilie Lambourg,Lesley Colvin,Greg Guthrie,Heather Walker,Samira Bell
出处
期刊:BJA: British Journal of Anaesthesia [Elsevier]
卷期号:128 (3): 546-561 被引量:3
标识
DOI:10.1016/j.bja.2021.08.035
摘要

Treating pain in the context of chronic kidney disease (CKD) is challenging because of altered pharmacokinetics and pharmacodynamics, with an increased risk of toxicity and drug adverse events in this population. The aims of this systematic review and meta-analysis were to assess the prevalence of analgesic use and establish the risk of analgesics-related adverse events, in patients with CKD.Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Medline, Embase, CINAHL, and CENTRAL were searched until January 2021. Random-effects meta-analyses and meta-regression were conducted to pool and summarise prevalence data and measures of association between analgesic use and adverse events.Sixty-two studies relevant to the prevalence of analgesic use and 33 to analgesic-related adverse events were included, combining data on 2.3 and 3 million individuals, respectively. Pooled analyses found that 41% (95% confidence interval [CI], 35-48) of the CKD population regularly use analgesia. The annual period prevalence was estimated at 50% for opioids and 21% for nonsteroidal anti-inflammatory drugs (NSAID). Overall, 20% and 7% of patients with CKD are on chronic opioid or NSAID therapy, respectively. Opioid use was associated with an increased risk of death (1.61; 95% CI, 1.12-2.31; n= 7, I2= 91%), hospitalisation (1.38; 95% CI, 1.32-1.45; n=2, I2=0%), and fractures (1.51; 95% CI, 1.16-1.96; n=3, I2=54%).High levels of analgesic consumption and related serious adverse outcomes were found in patients with CKD. Consideration needs to be given to how these patients are assessed and managed in order to minimise harms and improve outcomes.CRD42019156491 (PROSPERO).
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