Regular use of nephrotoxic medications is an independent risk factor for chronic kidney disease--results from a Chinese population study

Abstract

Prescription drug abuse is an important global health concern. Our previous survey in Beijing indicates that nephrotoxic medication use is independently associated with chronic kidney disease (CKD). In the present study, the study population consisted of participants from our previous survey with a confirmed history of nephrotoxic medication use. Nephrotoxic mediations included three antipyretic analgesics (58.2%) and three Chinese traditional medicines containing aristolochic acids (CTM-AAs, 47.3%). Prevalence of CKD (defined by presence of albuminuria and/or reduced estimated glomerular filtration rate) as well as markers of tubular injury was analysed, and compared with 109 age- and sex-matched controls. The prevalence of CKD was higher among medication users compared with controls, which was 18.3% and 8.5%, respectively. Among participants with medication use without CKD, markers of tubular injury including N-acetyl-β-d-glucosaminidase, transferrin and α(1)-microglobulin, were present in 26.6%. CKD was associated with CTM-AA use (cumulative AA-I dose > 0.5g, OR = 5.625, P<0.05) and antipyretic analgesic use (cumulative dose > 2.0kg, OR = 3.848, P = 0.063) in a dose-dependent manner. Albuminuria and tubular injury persisted among CTM-AA users, but not among analgesic users after cessation of drug. Our study suggests that education about rational analgesic use and CTM-AA banning may constitute an effective CKD prevention strategy.