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. 2016 Nov 30;20(1):389.
doi: 10.1186/s13054-016-1566-0.

Inhaled nitric oxide and the risk of renal dysfunction in patients with acute respiratory distress syndrome: a propensity-matched cohort study

Sheng-Yuan Ruan  1   2 , Hon-Yen Wu  3   4   5 , Hsien-Ho Lin  3 , Huey-Dong Wu  6 , Chong-Jen Yu  6 , Mei-Shu Lai  7
Affiliations

Inhaled nitric oxide and the risk of renal dysfunction in patients with acute respiratory distress syndrome: a propensity-matched cohort study

Sheng-Yuan Ruan et al. Crit Care. .

Abstract

Background: Inhaled nitric oxide (iNO) is a rescue therapy for severe hypoxemia in patients with acute respiratory distress syndrome (ARDS). Pooled data from clinical trials have signaled a renal safety warning for iNO therapy, but the significance of these findings in daily clinical practice is unclear. We used primary data to evaluate the risk of iNO-associated renal dysfunction in patients with ARDS.

Methods: We conducted a cohort study using data from a tertiary teaching hospital to evaluate the risk of incident renal replacement therapy (RRT) in iNO users compared with that of non-users. Propensity score matching and competing-risks regression were used for data analysis. Residual confounding was assessed by means of a rule-out approach. We also evaluated effect modification by pre-specified factors using stratified analysis.

Results: We identified 547 patients with ARDS, including 216 iNO users and 331 non-users. At study entry, 313 (57.2%) patients had moderate ARDS and 234 (42.8%) had severe ARDS. The mean patient age was 63 ± 17 years. The crude hazard ratio of the need for RRT in iNO users compared with non-users was 2.23 (95% CI, 1.61-3.09, p < 0.001). After propensity score matching, there were 151 iNO users matched to 151 non-users. The adjusted hazard ratio was 1.59 (95% CI, 1.08-2.34, p = 0.02). In the stratified analysis, we found that older aged patients (≥65 years) were more susceptible to iNO-associated kidney injury than younger patients (p = 0.05).

Conclusions: This study showed that iNO substantially increased the risk of renal dysfunction in patients with ARDS. Older aged patients were especially susceptible to this adverse event.

Keywords: Acute respiratory distress syndrome; Adverse effect; Nitric oxide; Renal failure; Treatment.

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Figures

Fig. 1
Fig. 1
Process for selection of study subjects. ARDS acute respiratory distress syndrome, iNO inhaled nitric oxide, ECMO extracorporeal membrane oxygenation, RRT renal replacement therapy
Fig. 2
Fig. 2
The cumulative incidence of the initiation of renal replacement therapy for inhaled nitric oxide (iNO) users and non-users in the propensity-matched cohort
Fig. 3
Fig. 3
Adjusted hazard ratios for the need for renal replacement therapy in patients treated with inhaled nitric oxide compared with that of non-users in the pre-specified subgroups. SAPS Simplified Acute Physiology Score
See this image and copyright information in PMC

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