Analgesic nephropathy in Hungary: the HANS study

Pintér, István; Mátyus, János; Czégány, Z; Harsányi, J.; Homoki, M; Kassai, Miklós; Kiss, Éva; Kiss, István; Ladányi, Erzsébet; Löcsey, L.; Major, Lajos; Misz, M; Nagy, L; Polner, Kálmán; Redl, J.; Solt, I; Tichy, B.; Török, Marietta; Varga, Gábor; Wágner, Gyula; Wórum, I; Pótó, László; Dérczy, Katalin; Wittmann, István; Nagy, Judit

doi:10.1093/ndt/gfh040

Cited by 16 publications

(17 citation statements)

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“…The concept of classic analgesic nephropathy 29 has now been largely attributed to abuse of phenacetin-containing analgesic mixtures, 30 which are no longer available in the United States, Australia, and most of Western Europe but continue to be associated with CKD and end-stage renal disease in countries where such mixtures are available. 31 This contradictory body of evidence may be one contributing factor to the continuing use of NSAIDs among persons with CKD. Common conditions with indications for NSAID use, particularly arthritis, may be more bothersome and limiting to overall quality of life than coexisting CKD, which is often without symptoms before end-stage renal disease.…”

Section: Informed Decision Making Regarding Nsaid Use In the Setting mentioning

confidence: 99%

Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

Plantinga¹,

Grubbs²,

Sarkar³

et al. 2011

The Annals of Family Medicine

104

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PURPOSE Because avoidance of nonsteroidal anti-infl ammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States.METHODS A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999Survey ( -2004 responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defi ned by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular fi ltration rate of 15-59 mL/min/1.73 m 2 ). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting.RESULTS Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P = .979). CONCLUSIONS INTRODUCTIONB oth over-the-counter and prescription nonsteroidal anti-infl ammatory drugs (NSAIDs) are widely used in the United States.1 General medicine textbooks [2][3][4] and nephrology subspecialty consensus guidelines (National Kidney Foundation) 5 recommend avoidance of NSAIDs (except aspirin and acetaminophen) for most patients with chronic kidney disease (CKD). Persons with CKD, however, are likely unaware of their disease 6 and may also be unaware that NSAIDs should be avoided. Additionally, those with CKD are likely to be older and have multiple comorbid conditions or symptoms that lead to increased use of NSAIDs. 7NSAIDs have been associated both with acute kidney injury in the general population 8 and with disease progression in those with CKD. 9For those with CKD, the further decrease in volume of renal blood fl ow resulting from decreased prostaglandin synthesis can lead to acute kidney injury, sodium retention, edema, hypertension, and hyperkalemia. Despite the potential adverse renal effects of NSAIDs, little is known about the patterns of NSAID use among those with CKD in community settings. Here we estimate the prevalence and describe patterns of self-reported NSAID use among adults by CKD status using data from the community-based National Health and Nutrition Examination Survey (NHANES). METHODS Study DesignWe conducted a cross-sectional study of participants from NHANES, which consists of standardized in-home interviews and physical examinations and specimen collections at mobile examination centers of representative samples of noninstitutionalized ...

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Section: Informed Decision Making Regarding Nsaid Use In the Setting mentioning

confidence: 99%

Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

Plantinga¹,

Grubbs²,

Sarkar³

et al. 2011

The Annals of Family Medicine

104

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“…In the study population, analgesic induced renal failure was noted in one patient, BPH in two, poly-cystic Kidney disease in three and renal calculi in three patients.Analgesics and non-steroidal anti-inflammatory drugs are among the most widely and frequently used drugs. Many studies[910] have suggested an association between chronic ingestion of analgesics and Kidney disease. It is characterized by Kidney papillary necrosis and chronic interstitial nephritis that leads to insidious onset of progressive Kidney failure.…”

Section: Discussionmentioning

confidence: 99%

A clinical comparative study of the management of chronic renal failure with Punarnavadi compound

Prashanth

Baghel

Ravishankar

et al. 2010

AYU

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India like any other country is facing a silent epidemic of chronic renal failure (CRF)- a facet of the health transition associated with industrialization partly fuelled by increase in sedentary lifestyle, low birth weight and malnutrition. Increasing figures by many folds seen is posing a difficult situation to overcome with respect to economy and health of the working and earning population of the nation. There is an urgent need to explore, highlight new interventions and modify modifiable risk factors as a basis for treatment strategies to prevent the development and progression of CRF. The present study was taken up to evaluate the role of trial formulation tab. Punarnavadi compound in the management of chronic renal failure. This was an open clinical comparative study in controlled circumstances wherein 67 patients were studied for two months in three groups- Group A (allopathic control), Group B (ayurvedic control) and Group C (ayurvedic test). It was a multi-centric study; patients were registered from Anandababa charitable dialysis centre, Jamnagar, Kayachikitsa O.P.D. of I.P.G.T. and R.A. Jamnagar and P. D. Patel Ayurveda hospital, Nadiad. Results were assessed on 15 parameters using Students (paired) ‘t’ test. Group A patients showed comparatively better results in eight parameters- weight, platelet count, serum urea, serum uric acid, serum sodium, potassium, chloride and total proteins. Parameter Hemoglobin% showed better results in Group B patients and in Group C patients comparatively better results in six parameters viz.- quality of life (breathlessness, weakness, general functional capacity), total count, serum creatinine and serum calcium - were observed. Throughout the study, trial drug tab. Punarnavadi compound did not show any adverse drug reaction. The results of this study will help in developing a cheap and safe treatment for the management of CRF.

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“…Formerly one of the commoner causes of end-stage renal failure (ESRF), there has been a marked decline in the prevalence and incidence of AN in recent decades 12). At its peak in the 1980s, AN accounted for 15% to 20% of cases of ESRF, but has fallen to approximately 1% in Western countries today 34567)…”

Section: Introductionmentioning

confidence: 99%

“…This combination of features is seldom seen in other diseases. No histologic changes are diagnostic of AN, but papillary necrosis and chronic interstitial nephritis are both characteristic of the condition 4510)…”

Section: Introductionmentioning

confidence: 99%

Common Analgesic Agents and Their Roles in Analgesic Nephropathy: A Commentary on the Evidence

Yaxley

2016

Korean J Fam Med

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An association between non-opioid analgesic agents and chronic kidney disease has long been suspected. The presumed development of chronic renal impairment following protracted and excessive use of non-opioid analgesia is known as analgesic nephropathy. Many clinicians accept analgesic nephropathy as a real entity despite the paucity of scientific evidence. This narrative review aims to summarize the literature in the field. The weight of available observational literature suggests that long-term ingestion of paracetamol and combination mixtures of aspirin and paracetamol are likely to contribute to chronic renal impairment. However, there is no convincing data to implicate non-steroidal anti-inflammatory drugs or aspirin monotherapy in the development of analgesic nephropathy. In the absence of high-level evidence, while controversy persists, it may be prudent for physicians to consider all non-narcotic analgesics to be nephrotoxic with long-term use.

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Analgesic nephropathy in Hungary: the HANS study

Abstract: Phenacetin should be banned. Our study results support the need for longitudinal cohort and case-control studies in Hungary.

Cited by 16 publications

References 11 publications

Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

A clinical comparative study of the management of chronic renal failure with Punarnavadi compound

Common Analgesic Agents and Their Roles in Analgesic Nephropathy: A Commentary on the Evidence

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