Abstract
Objectivesto establish and quantify any observable association between the exposure to community prescriptions for quinine and acute kidney injury (AKI) events in a population of older adults.Designtwo observational studies using the same dataset, a retrospective longitudinal cohort study and a self-controlled case series (SCCS).SettingNHS health board in Scotland.Participantsolder adults (60+ years) who received quinine prescriptions in Tayside, Scotland, between January 2004 and December 2015. The first study included 12,744 individuals. The SCCS cohort included 5,907 people with quinine exposure and more than or equal to one AKI event.Main outcome measuredin the first study, multivariable logistic regression was used to calculate odds ratios (ORs) for AKI comparing between episodes with and without recent quinine exposure after adjustment for demographics, comorbidities and concomitant medications. The SCCS study divided follow-up for each individual into periods ‘on’ and ‘off’ quinine, calculating incidence rate ratios (IRRs) for AKI adjusting for age.Resultsduring the study period, 273,596 prescriptions for quinine were dispensed in Tayside. A total of 13,616 AKI events occurred during follow-up (crude incidence 12.5 per 100 person-years). In the first study, exposure to quinine before an episode of care was significantly associated with an increased probability of AKI (adjusted OR = 1.27, 95% confidence interval (CI) 1.21–1.33). In the SCCS study, exposure to quinine was associated with an increased relative incidence of AKI compared to unexposed periods (IRR = 1.20, 95% CI 1.15–1.26), with the greatest risk observed within 30 days following quinine initiation (IRR = 1.48, 95% CI 1.35–1.61).Conclusioncommunity prescriptions for quinine in an older adult population are associated with an increased risk of AKI.
Highlights
Acute kidney injury (AKI) is associated with a number of negative outcomes including short- and long-term mortality [1,2,3] and the development of chronic kidney disease (CKD) [3, 4]
In the self-controlled case series (SCCS) study, exposure to quinine was associated with an increased relative incidence of acute kidney injury (AKI) compared to unexposed periods (IRR = 1.20, 95% confidence intervals (CIs) 1.15–1.26), with the greatest risk observed within 30 days following quinine initiation (IRR = 1.48, 95% CI 1.35–1.61)
This is the first study to examine the association between quinine exposure and AKI at a population level
Summary
Acute kidney injury (AKI) is associated with a number of negative outcomes including short- and long-term mortality [1,2,3] and the development of chronic kidney disease (CKD) [3, 4]. Identifying modifiable individual risk factors, such as nephrotoxic medications, is an important target towards which preventative efforts can be directed, in the older population [7]. A number of these conditions overlap with risk factors for AKI, notably the use of diuretics, CKD, volume depletion and increased age [7, 10]. Quinine itself can precipitate AKI by immune-mediated reactions, notably drug-induced thrombotic microangiopathy (TMA) of which it is the most common cause [13, 14]. Despite leg cramps sharing a number of common risk factors with AKI, and quinine itself known to affect the kidney by rare immune-mediated reactions, the relationship between cramps, quinine and AKI at a population level is unclear. The aim of this study is to establish and quantify any observable association between the exposure to community prescriptions for quinine and AKI events in a population of older adults
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