XXXX - @entity1063 Reuptake Inhibitors and the Risk of AKI: A Cohort Study of Eight Administrative Databases and Meta-Analysis.

@entity1 @entity6 @entity21553 @entity4480 @entity750 @entity906 @entity1063
BACKGROUND AND OBJECTIVES: A safety signal regarding cases of AKI after exposure to @entity750 - @entity1063 reuptake inhibitors (SNRIs) was identified by Health Canada. Therefore, this study assessed whether the use of SNRIs increases the risk of AKI compared with selective @entity750 reuptake inhibitors (SSRIs) and examined the risk associated with each individual SNRI. DESIGN, SETTING, @entity1 , _ MEASUREMENTS: Multiple retrospective population-based cohort studies were conducted within eight administrative databases from Canada, the United States, and the United Kingdom between January 1997 and March 2010. Within each cohort, a nested case-control analysis was performed to estimate incidence rate ratios (RRs) of AKI associated with SNRIs compared with SSRIs using conditional logistic regression, with adjustment for high-dimensional propensity scores. The overall effect across sites was estimated using meta-analytic methods. RESULTS: There were 38,974 cases of AKI matched to 384,034 controls. Current use of SNRIs was not associated with a higher risk of AKI compared with SSRIs (fixed-effect RR, 0.97; 95% confidence interval [95% CI], 0.94 to 1.01). Current use of @entity906 and @entity21553 considered together was not associated with a higher risk of AKI (RR, 0.96; 95% CI, 0.92 to 1.00). For current use of @entity4480 , there was significant heterogeneity among site-specific estimates such that a random-effects meta-analysis was performed showing a 16% higher risk, although this risk was not statistically significant (RR, 1.16; 95% CI, 0.96 to 1.40). This result is compatible with residual confounding, because there was a substantial imbalance in the prevalence of @entity6 between users of @entity4480 and users of others SNRIs or SSRIs. After further adjustment by including @entity6 as a covariate in the model along with propensity scores, the fixed-effect RR was 1.02 (95% CI, 0.95 to 1.10). CONCLUSIONS: There is no evidence that use of SNRIs is associated with a higher risk of hospitalization for AKI compared with SSRIs.
