Hospitalized poisonings after renal transplantation in the United States

BMC Nephrology

Lawrence Y Agodoa¹  Rebecca A Viola³  Kevin C Abbott² 

[1] NIDDK, NIH, Bethesda, MD, USA;Nephrology Service, Walter Reed Army Medical Center, Washington, D.C., and Uniformed Services University of the Health Sciences, Bethesda, MD, USA;Pharmacy Service, Walter Reed Army Medical Center, Washington, D.C, USA

关键词: pharmacist;    USRDS;    complications;    diabetes;    rejection;    body mass index;    medication error;    drug overdose;    poisonings;   

Others  :  1083457
DOI  :  10.1186/1471-2369-3-10

 received in 2002-09-27, accepted in 2002-11-26,  发布年份 2002

【 摘 要 】

Background

The national incidence of and risk factors for hospitalized poisonings in renal transplant recipients has not been reported.

Methods

Historical cohort study of 39,628 renal transplant recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. Associations with time to hospitalizations for a primary diagnosis of poisonings (ICD-9 codes 960.x-989.x) within three years after renal transplant were assessed by Cox Regression.

Results

The incidence of hospitalized poisonings was 2.3 patients per 1000 person years. The most frequent causes of poisonings were immunosuppressive agents (25.3%), analgesics/antipyretics (14.1%), psychotropic agents (10.0%), and insulin/antidiabetic agents (7.1%). In Cox Regression analysis, low body mass index (BMI, <21.6 vs. >28.3 kg/m², adjusted hazard ratio (AHR), 3.02, 95% CI, 1.45–6.28, and allograft rejection, AHR 1.83, 95% CI, 1.15–2.89, were the only factors independently associated with hospitalized poisonings. Hospitalized poisonings were independently associated with increased mortality (AHR, 1.54, 95% CI 1.22–1.92, p = 0.002).

Conclusions

Hospitalized poisonings were associated with increased mortality after renal transplantation. However, almost all reported poisonings in renal transplant recipients were due to the use of prescribed medications. Allograft rejection and low BMI were the only independent risk factors for poisonings identified in this population.

【 授权许可】

   
2002 Abbott et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

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【 参考文献 】

• [1][http://www.cdc.gov/nchs] webcite
• [2]Chang SH, Lim CS, Low TS, Chong HT, Tan SY: Cyclosporine-associated encephalopathy: a case report and literature review. Transplant Proc 2001, 33:3700-1.
• [3]Wong EH, Chan NN, Sze KH, Or KH: Serotonin syndrome in a renal transplant patient. J R Soc Med 2002, 95:304-5.
• [4]Chari RS, Hemming AW, Cattral M: Successful kidney pancreas transplantation from donor with methanol intoxication. Transplantation 1998, 66:674-5.
• [5]Ravishankar DK, Kashi SH, Lam FT: Organ transplantation from donor who died of cyanide poisoning: a case report. Clin Transplant 1998, 12:142-3.
• [6]Abbott KC, Duran M, Hypolite I, et al.: Hospitalizations for bacterial endocarditis after renal transplantation in the United States. J Nephrol 2001, 14:353-60.
• [7]Tveit DP, Hypolite I, Bucci J, et al.: Risk factors for hospitalizations resulting from pulmonary embolism after renal transplantation in the United States. J Nephrol 2001, 14:361-8.
• [8]Abbott KC, Hypolite IO, Hshieh P, et al.: Hospitalized congestive heart failure after renal transplantation in the United States. Ann Epidemiol 2002, 12:115-22.
• [9]Abbott KC, Bucci JR, Cruess D, Taylor AJ, Agodoa LY: Graft loss and acute coronary syndromes after renal transplantation in the United States. J Am Soc Nephrol 2002, 13:2560-9.
• [10]Hypolite IO, Bucci J, Hshieh P, Cruess D, Agodoa LY, Yuan CM, Taylor AJ, Abbott KC: Acute coronary syndromes after renal transplantation in patients with end-stage renal disease resulting from diabetes. Am J Transplant 2002, 2:274-81.
• [11]David KleinbaumG: Survival Analysis :. In A Self-Learning Text (Statistics in the Health Sciences). Springer Verlag; New York, New York; May 1996
• [12]Kruger HU, Bross-Bach U, Proksch B, Schmidt H, Dopfer R, Ehninger G: A case of accidental cyclosporin overdose with pharmacokinetic analysis. Bone Marrow Transplant 1988, 3:167-9.
• [13]Yeh CN, Hsieh CH, Hung CM, Jeng LB, Chao TC, Chen MF: Acute overdoses of tacrolimus (FK 506). Dig Dis Sci 1999, 44:1650-2.
• [14]Dines CM: Improving renal transplant pain management. Hosp Case Manag 1999, 7:105-7.
• [15]Abbott K, Hypolite I, Viola R, Poropatich R, Hshieh P, Cruess D, Hawkes C, Agodoa L: Hospitalizations for cytomegalovirus disease after renal transplantation in the United States. Ann Epidemiol 2002, 12:402.
• [16]Bechstein WO: Neurotoxicity of calcineurin inhibitors: impact and clinical management. Transpl Int 2000, 13:313-26.
• [17]Vella JP, Sayegh MH: Interactions between cyclosporine and newer antidepressant medications. Am J Kidney Dis 1998, 31:320-3.
• [18]Matzke GR, St Peter WL, Comstock TJ, Foote EF: Nephrology pharmaceutical care preceptorship: a programmatic and clinical outcomes assessment. Ann Pharmacother 2000, 34:593-9.
• [19]Kliger AS, Diamond LH: Patient safety in end-stage renal disease: How do we create a safe environment? Adv Ren Replace Ther 2001, 8:131-7.
• [20]Wong KM, Shek CC, Chau KF, Li CS: Abbreviated Tacrolimus Area-Under-the-Curve Monitoring for Renal Transplant Recipients. Am J Kidney Dis 2000, 35(4):660-666.
• [21][http:/ / www.wramc.amedd.army.mil/ departments/ Medicine/ Nephrology/ sop/ txp/ txpmedprotocol.cfm] webcite 8/27/2002
• [22]Chisholm MA, Mulloy LL, Jagadeesan M, DiPiro JT: Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications. Clin Transplant 2001, 15:330-6.
• [23]Estimating workforce and training requirements for nephrologists through the year 2010. Ad Hoc Committee on Nephrology Manpower Needs. J Am Soc Nephrol 1997, 8:S9-13. i–xxii, 1–32 passim
• [24]Bond MA: Health promotion and disease prevention in kidney transplant recipients. J Transpl Coord 1998, 8:221-4.