PURPOSE: The effects of nonselective and selective cyclooxygenase-2 specific (COX-2) nonsteroidal anti-inflammatory drug (NSAID) use on the progression of chronic kidney disease (CKD) is uncertain. Due to the high prevalence of both CKD and NSAID use in older adults, we sought to determine the association between NSAID use and the progression of CKD in an elderly community-based cohort. METHODS: All subjects > or =66 years of age who had at least one serum creatinine measurement in 2 time periods (July-December, 2001 and July-December, 2003) were included. Multiple logistic regression analyses, including covariates for age, sex, baseline estimated glomerular filtration rate (eGFR), diabetes, and comorbidity were used to explore the associations of NSAID use on the primary (decrease in eGFR of > or =15 mL/min/1.73) and secondary (mean change in eGFR) outcomes. RESULTS: A total of 10,184 subjects (mean age 76 years; 57% female) were followed for a median of 2.75 years. High-dose NSAID users (upper decile of cumulative NSAID exposure) experienced a 26% increased risk for the primary outcome (odds ratio [OR] 1.26, 95% confidence interval [CI], 1.04-1.53). A linear association between cumulative NSAID dose and change in mean GFR also was seen. No risk differential was identified between selective and nonselective NSAID users. CONCLUSIONS: High cumulative NSAID exposure is associated with an increased risk for rapid CKD progression in the setting of a community-based elderly population. For older adult patients with CKD, these results suggest that nonselective NSAIDs and selective COX-2 inhibitors should be used cautiously and chronic exposure to any NSAID should be avoided.
PURPOSE: The effects of nonselective and selective cyclooxygenase-2 specific (COX-2) nonsteroidal anti-inflammatory drug (NSAID) use on the progression of chronic kidney disease (CKD) is uncertain. Due to the high prevalence of both CKD and NSAID use in older adults, we sought to determine the association between NSAID use and the progression of CKD in an elderly community-based cohort. METHODS: All subjects > or =66 years of age who had at least one serum creatinine measurement in 2 time periods (July-December, 2001 and July-December, 2003) were included. Multiple logistic regression analyses, including covariates for age, sex, baseline estimated glomerular filtration rate (eGFR), diabetes, and comorbidity were used to explore the associations of NSAID use on the primary (decrease in eGFR of > or =15 mL/min/1.73) and secondary (mean change in eGFR) outcomes. RESULTS: A total of 10,184 subjects (mean age 76 years; 57% female) were followed for a median of 2.75 years. High-dose NSAID users (upper decile of cumulative NSAID exposure) experienced a 26% increased risk for the primary outcome (odds ratio [OR] 1.26, 95% confidence interval [CI], 1.04-1.53). A linear association between cumulative NSAID dose and change in mean GFR also was seen. No risk differential was identified between selective and nonselective NSAID users. CONCLUSIONS: High cumulative NSAID exposure is associated with an increased risk for rapid CKD progression in the setting of a community-based elderly population. For older adult patients with CKD, these results suggest that nonselective NSAIDs and selective COX-2 inhibitors should be used cautiously and chronic exposure to any NSAID should be avoided.
Authors: David D Odineal; Maria T Marois; Deborah Ward; Christopher H Schmid; Rima Cabrera; Ida Sim; Youdan Wang; Barth Wilsey; Naihua Duan; Stephen G Henry; Richard L Kravitz Journal: J Gen Intern Med Date: 2019-08-28 Impact factor: 5.128
Authors: Luke S Vest; Nagaraju Sarabu; Farrukh M Koraishy; Minh-Tri Nguyen; Meyeon Park; Ngan N Lam; Mark A Schnitzler; David Axelrod; Chi Yuan Hsu; Amit X Garg; Dorry L Segev; Allan B Massie; Gregory P Hess; Bertram L Kasiske; Krista L Lentine Journal: Clin Transplant Date: 2020-06-29 Impact factor: 2.863
Authors: Lesley A Inker; Marcello Tonelli; Brenda R Hemmelgarn; Emily B Levitan; Paul Muntner Journal: Am J Kidney Dis Date: 2011-11-23 Impact factor: 8.860
Authors: Brenda R Hemmelgarn; Fiona Clement; Braden J Manns; Scott Klarenbach; Matthew T James; Pietro Ravani; Neesh Pannu; Sofia B Ahmed; Jennifer MacRae; Nairne Scott-Douglas; Kailash Jindal; Robert Quinn; Bruce F Culleton; Natasha Wiebe; Richard Krause; Laurel Thorlacius; Marcello Tonelli Journal: BMC Nephrol Date: 2009-10-19 Impact factor: 2.388