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dc.rights.licenseAtribución-SinDerivadas 4.0 Internacional
dc.contributor.advisorNavarro Vargas, José Ricardo
dc.contributor.advisorBuitrago Gutiérrez, Giancarlo
dc.contributor.advisorContreras Villamizar, Kateir
dc.contributor.authorRamirez Pimiento, Juan David
dc.description.abstractDipyrone and diclofenac are common analgesics for joint replacement surgery. Nevertheless the risk of acute kidney injury associated to the use of NSAID might be higher in this population Objective: to study the association between dipyrone, diclofenac or the combination of both for joint replacement surgery analgesia and the incidence of acute kidney injury that requires renal replacement therapy (RRT) and mortality. Methods: A retrospective cohort study was made. Data was collected through a national database of procedures made in the contribute social security system and analysed with a logical regression model. Results: a total of 5078 procedures were obtained. Patients were divided by age, Charlson comorbidity Index (CCI) and geographic location of the procedure. After multivariate analysis an association was found between male gender, a higher CCI and the outcome of RRT; meanwhile male gender, older age and a higher CCI were all associated with a higher mortality. Conclusions: Adding dipyrone to diclofenac for perioperative analgesia doesn’t seem to increase the risk of RRT or mortality outcomes in patients taken for joint replacement surgery. However it is not possible to determine the safety of dipyrone in older and morbid patients in which diclofenac might be deleterious. Further studies are required to clarify whether dipyrone is safe when combined with NSAID. Key words: Dipyrone (Metamizole), Diclofenac, Acute kidney Injury, Dialysis, Arthroplasty,
dc.description.abstractComo parte de la analgesia en la cirugía de reemplazo articular es común el uso de dipirona y diclofenaco. Sin embargo, existe riesgo de lesión renal aguda asociado al uso de los antiinflamatorios no esteroideos, particularmente en estos pacientes. Objetivo: determinar la relación entre el uso de dipirona, diclofenaco o la combinación de ambos para analgesia en cirugía de reemplazo articular y la incidencia de lesión renal aguda con requerimiento de terapia de reemplazo renal (TRR) y mortalidad. Métodos: se realizó un estudio retrospectivo de cohortes a partir de una base de datos de pacientes y procedimientos pertenecientes al régimen contributivo y se analizó con modelos de regresión logística Resultados: se obtuvieron un total de 5078 procedimientos en el periodo estudiado. Se dividieron los pacientes en categorías por edad, Índice de comorbilidades de Charlson (ICC) y región geográfica del país. Se encontró una mortalidad de 3,45% y una incidencia de TRR de 0,7%. Tras un análisis multivariado se encontró que el género masculino, y un mayor ICC se asociaron a un mayor requerimiento de TRR; Mientras que el género masculino, la mayor edad y un ICC se asociaron a una mayor mortalidad. Conclusiones: La adición de Dipirona al Diclofenaco parece no aumentar el requerimiento de TRR o la mortalidad en pacientes llevados a cirugía de reemplazo articular, sin embargo no es posible determinar la seguridad de la dipirona en pacientes en quienes el uso del diclofenaco puede ser perjudicial. Se requieren más estudios para aclarar el perfil de seguridad de la dipirona y su combinación con antiinflamatorios no esteroideos. Palabras clave: Dipirona (metamizol), Diclofenaco, Lesión renal aguda, Diálisis, artroplastia.
dc.rightsDerechos reservados - Universidad Nacional de Colombia
dc.subject.ddcMedicina y salud::Farmacología y terapéutica
dc.titleEfecto del manejo analgésico perioperatorio con dipirona y/o diclofenaco en la incidencia de lesión renal aguda con requerimiento de terapia de reemplazo renal en pacientes llevados a cirugía de reemplazo articular en Colombia, un estudio retrospectivo
dc.title.alternativeRenal replacement therapy after perioperative analgesia with diclofenac, dipyrone of both after joint replacement surgery in Colombia, a poblational retrospective study
dc.typeDocumento de trabajo
dc.rights.spaAcceso abierto
dc.coverage.sucursalUniversidad Nacional de Colombia - Sede Bogotá
dc.description.additionalEspecialista en Anestesiología y Reanimación
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
dc.relation.referencesLau YC, Irwin MG. Anaesthesia for joint replacement surgery. Anaesth Intensive Care Med. 2018;19(4):171–4. 2. Schneider V, Lévesque LE, Zhang B, Hutchinson T, Brophy JM. Association of selective and conventional nonsteroidal antiinflammatory drugs with acute renal failure: A population-based, nested case-control analysis. Am J Epidemiol. 2006;164(9):881–9. 3. Zhang X, Donnan PT, Bell S, Guthrie B. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: Systematic review and meta-analysis. BMC Nephrol. 2017;18(1):1–12. 4. Murray MD, Brater DC, Tierney WM, Hui SL, McDonald CJ. Ibuprofen-associated renal impairment in a large general internal medicine practice. Am J Med Sci. 1990 Apr;299(4):222–9. 5. Park S, Lee S, Lee A, Paek JH, Chin HJ, Na KY, et al. Awareness, incidence and clinical signi fi cance of acute kidney injury after non-general anesthesia. 2018;0(April). 6. Kötter T, Da Costa BR, Fässler M, Blozik E, Linde K, Jüni P, et al. Metamizole-associated adverse events: A systematic review and meta-analysis. PLoS One. 2015;10(4):1–18. 7. Matthews ML. The role of dose reduction with NSAID use. Am J Manag Care. 2013;19(14 SUPPL.):273–7. 8. Chang Y-K, Liu J-S, Hsu Y-H, Tarng D-C, Hsu C-C. Increased Risk of End-Stage Renal Disease (ESRD) Requiring Chronic Dialysis is Associated With Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Medicine (Baltimore). 2015 Sep;94(38):e1362. 9. Gharaibeh KA, Hamadah AM, Sierra RJ, Leung N, Kremers WK. The Rate of Acute Kidney Injury After Total Hip. 2017;1819–26. 10. Ying T, Chan S, Lane S, Somerville C. Acute kidney injury post-major orthopaedic surgery: A single-Centre case-control study. Nephrology. 2018 Feb 1;23(2):126–32. 11. Rahman S, Malcoun A. Nonsteroidal Antiinflammatory Drugs, Cyclooxygenase-2, and the Kidneys. Prim Care - Clin Off Pract. 2014;41(4):803–21. 12. Chandrasekharan N V, Dai H, Roos KLT, Evanson NK, Tomsik J, Elton TS, et al. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proc Natl Acad Sci U S A. 2002 Oct 15;99(21):13926–31. 13. Dixit M, Doan T, Kirschner R, Dixit N. Significant acute kidney injury due to non-steroidal antiinflammatory drugs: Inpatient setting. Pharmaceuticals. 2010;3(4):1279–85. 14. Hörl WH. Nonsteroidal anti-inflammatory drugs and the kidney. Pharmaceuticals. 2010;3(7):2291–321. 15. Vane JR. The fight against rheumatism: from willow bark to COX-1 sparing drugs. J Physiol Pharmacol. 2000 Dec;51(4 Pt 1):573–86. 16. Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions--2. Br Med J (Clin Res Ed). 1986 May 3;292(6529):1190–1. 17. Dreischulte T, Morales DR, Bell S, Guthrie B. Combined use of nonsteroidal anti-inflammatory drugs with diuretics and/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury. Kidney Int. 2015;88(2):396–403. 18. Stamer UM, Soehle M, Park T-W, Fischer M, Stuber F. Anaphylactic reaction after intravenous dipyrone. Acute Pain. 2007 Dec 1;9(4):221–7. 19. Buitrago-González TP, Calderón-Ospina CA, Vallejos-Narváez Á. Dipirona: ¿Beneficios subestimados o riesgos sobredimensionados? Revisión de la literatura. Rev Colomb Ciencias Químico-Farmacéuticas. 2014 Jun 30;43(1):173–95. 20. Derry S, Faura C, Edwards J, McQuay HJ, Moore RA. Single dose dipyrone for acute postoperative pain. In: Derry S, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2010. 21. Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A, et al. Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth. 2008 Mar;20(2):103–8. 22. Torres LM, Rodríguez MJ, Montero A, Herrera J, Calderón E, Cabrera J, et al. Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study. Reg Anesth Pain Med. 26(2):118–24. 23. Becker ST, Wiltfang J, Springer IN, Bartsch MS, Guenther R, Sherry E, et al. Life-threatening bite injury of the lower lip after use of metamizole. Oral Maxillofac Surg. 2008 May 24;12(1):39–41. 24. Schönhöfer P, Offerhaus L, Herxheimer A. Dipyrone and agranulocytosis: what is the risk? Lancet (London, England). 2003 Mar 15;361(9361):968–9. 25. Nikolova I, Petkova V, Tencheva J, Benbasat N, Voinikov J, Danchev N. Metamizole: A review profile of a well-known “forgotten” drug. part ii: Clinical profile. Biotechnol Biotechnol Equip. 2013;27(2):3605–19. 26. Andrade S, Bartels DB, Lange R, Sandford L, Gurwitz J. Safety of metamizole: a systematic review of the literature. J Clin Pharm Ther. 2016 Oct 1;41(5):459–77. 27. Machado-Alba JE, Urbano-Garzón SF, Gallo-Gómez YN, Zuluaica S, Henao Y, Parrado-Fajardo IY. Reacción de anafilaxia grave por dipirona sin antecedente de hipersensibilidad. Informe de caso. Rev Colomb Anestesiol. 2017 Jan 1;45:8–11. 28. Ungprasert P, Cheungpasitporn W, Crowson CS, Matteson EL. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26(4):285–91. 29. González-cárdenas VH, Laverde-gaona LA, Sergio H. Colombian Journal of Anesthesiology Análisis de la incidencia de eventos adversos relacionados a aplicación de dipirona Analysis of the incidence of adverse events related to the administration of dipyrone. 2018;46(2):121–7. 30. Hassan K, Khazim K, Hassan F, Hassan S. Acute kidney injury associated with metamizole sodium ingestion. Ren Fail. 2011;33(5):544–7. 31. Altman R, Bosch B, Kay Brune •, Patrignani P, Young C. Advances in NSAID Development: Evolution of Diclofenac Products Using Pharmaceutical Technology. Drugs. 75. 32. Derry S, Wiffen PJ, Moore RA. Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2015 Jul 7;(7). 33. TEGEDER I, LOTSCH J, KREBS S, MUTHSELBACH U, BRUNE K, GEISSLINGER G. Comparison of inhibitory effects of meloxicam and diclofenac on human thromboxane biosynthesis after single doses and at steady state. Clin Pharmacol Ther. 1999 May;65(5):533–44. 34. van Walsem A, Pandhi S, Nixon RM, Guyot P, Karabis A, Moore RA. Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis. Arthritis Res Ther. 2015 Mar 19;17(1):66. 35. Pavelka K. A comparison of the therapeutic efficacy of diclofenac in osteoarthritis: a systematic review of randomised controlled trials. Curr Med Res Opin. 2012 Jan 14;28(1):163–78. 36. McNicol ED, Ferguson MC, Schumann R. Single-dose intravenous diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018 Aug 28;8:CD012498. 37. Gan TJ. Diclofenac: an update on its mechanism of action and safety profile. Curr Med Res Opin. 2010 Jul 17;26(7):1715–31. 38. Dubreuil M, Louie-Gao Q, Peloquin CE, Choi HK, Zhang Y, Neogi T. Risk of myocardial infarction with use of selected non-steroidal anti-inflammatory drugs in patients with spondyloarthritis and osteoarthritis. Ann Rheum Dis. 2018;77(8):1137–42. 39. Schmidt M, Sørensen HT, Pedersen L. Diclofenac use and cardiovascular risks: series of nationwide cohort studies. BMJ. 2018 Sep 4;362:k3426. 40. Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Moore M, editor. Cochrane Database Syst Rev. 2011 Sep 7;(9). 41. Griffin MR, Yared A, Ray WA. Nonsteroidal antiinflammatory drugs and acute renal failure in elderly persons. Am J Epidemiol. 2000;151(5):488–96. 42. Chertow GM, Burdick E, Honour M, Bonventre J V, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005 Nov 1;16(11):3365–70. 43. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012 Mar;81(5):442–8. 44. Murugan R, Kellum JA. Acute kidney injury: what’s the prognosis? Nat Rev Nephrol. 2011 Apr 22;7(4):209–17. 45. Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al. World Incidence of AKI: A Meta-Analysis. Clin J Am Soc Nephrol. 2013 Sep 6;8(9):1482–93. 46. Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, et al. Cost and Mortality Associated With Postoperative Acute Kidney Injury. Ann Surg. 2015 Jun;261(6):1207–14. 47. Macheras GA, Kateros K, Koutsostathis SD, Papadakis SA, Tsiridis E. Which patients are at risk for kidney dysfunction after hip fracture surgery? Clin Orthop Relat Res. 2013 Dec;471(12):3795–802.
dc.subject.proposalDipyrone (Metamizole)
dc.subject.proposalLesión renal aguda
dc.subject.proposalAcute kidney Injury

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