Analgesic use and associated adverse events in patients with chronic kidney disease: a systematic review and meta-analysis

Lambourg, Emilie; Guthrie, Greg; Walker, Heather; Bell, Samira

doi:10.1016/j.bja.2021.08.035

Cited by 9 publications

(9 citation statements)

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“…Shifting to another class of analgesics (e.g. opioids) may be associated with a separate set of adverse effects, dependence and increased mortality [18 ▪ ]. NSAIDs can be used cautiously, using the lowest possible dose for the shortest possible period of time to control pain while monitoring BP and kidney function.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have examined the association between NSAIDs and CKD progression, but their results remain controversial [20]. Lambourg et al [18 ▪ ] conducted a meta-analysis that examined three studies in patients with eGFR of 45–60 ml/min/1.73 m 2 or less who were using NSAIDs to examine the incidence of CKD progression compared with a group without NSAID use. The meta-analysis observed no association between NSAID consumption and CKD progression, but it is essential to mention that it did discern an increased risk of AKI in patients with CKD consuming NSAIDs [18 ▪ ].…”

Section: Nsaids and Chronic Kidney Diseasementioning

confidence: 99%

“…Lambourg et al [18 ▪ ] conducted a meta-analysis that examined three studies in patients with eGFR of 45–60 ml/min/1.73 m 2 or less who were using NSAIDs to examine the incidence of CKD progression compared with a group without NSAID use. The meta-analysis observed no association between NSAID consumption and CKD progression, but it is essential to mention that it did discern an increased risk of AKI in patients with CKD consuming NSAIDs [18 ▪ ]. Quite contrary, a retrospective study in Japan (925 patients with CKD) showed an increased incidence of CKD progression to dialysis in those using NSAIDs (267.12/10 000 person-years) [21] compared with the national prevalence rate for dialysis (26.9/10 000) [22].…”

Section: Nsaids and Chronic Kidney Diseasementioning

confidence: 99%

“…However, the high prevalence of pain in patients with CKD makes the decision on a pain control regimen very challenging [17] because other alternatives (e.g. opioids) have a wide range of side effects that makes the necessity to avoid NSAIDs debatable [18 ▪ ].…”

Section: Nsaids and Chronic Kidney Diseasementioning

confidence: 99%

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Literature review: are NSAIDs harmful and is acetaminophen well tolerated?

Abbasi¹

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewOn the basis of previous literature, NSAID use is typically avoided in patients at risk for kidney disease, while acetaminophen has generally been considered well tolerated. However, the extent of NSAID effect on the kidneys is not clear, especially in chronic kidney disease (CKD), and the concerns about the safety of acetaminophen have been rising. In this review, we will discuss the latest evidence of the effects of NSAIDs and acetaminophen in the context of nephrology and hypertension. Recent findingsThe risk of acute kidney injury (AKI) by NSAIDs is higher with longer courses and in the presence of several factors such as older age, diabetes mellitus, lower eGFR, diuretic use and cardiovascular disease. The timing of NSAID use in relation to the onset of AKI may affect its progression. Regular NSAID use could be associated with an increased incidence of CKD, but the relation between NSAID use and CKD progression is less clear. Regular acetaminophen use was associated with increased SBP, while its use could have a renoprotective effect in certain situations.

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Section: Discussionmentioning

confidence: 99%

Section: Nsaids and Chronic Kidney Diseasementioning

confidence: 99%

Section: Nsaids and Chronic Kidney Diseasementioning

confidence: 99%

Section: Nsaids and Chronic Kidney Diseasementioning

confidence: 99%

See 2 more Smart Citations

Literature review: are NSAIDs harmful and is acetaminophen well tolerated?

Abbasi¹

2023

Current Opinion in Nephrology &Amp; Hypertension

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“…To relieve pain, these patients are conventionally given oral nonsteroidal anti-inflammatory drugs (NSAID) or opioids [ 17 ]. Unfortunately, the side effects of NSAID and opioids, such as digestive hemorrhage, liver injury, and drug addiction, frequently lead to the failure of antalgic therapy [ 18 ]. Up to now, tumor-targeted drug delivery is of increasing interest from bench to bedside.…”

Section: Introductionmentioning

confidence: 99%

One-step fabrication of lidocaine/CalliSpheres® composites for painless transcatheter arterial embolization

et al. 2022

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Background Transcatheter arterial embolization (TAE) is one of the first-line treatments for advanced hepatocellular cancer. The pain caused by TAE is a stark complication, which remains to be prevented by biomedical engineering methods. Methods Herein, a commercial embolic agent CalliSpheres® bead (CB) was functionally modified with lidocaine (Lid) using an electrostatic self-assembly technique. The products were coded as CB/Lid-n (n = 0, 5, 10, corresponding to the relative content of Lid). The chemical compositions, morphology, drug-loading, and drug-releasing ability of CB/Lid-n were comprehensively investigated. The biocompatibility was determined by hemolysis assay, live/dead cell staining assay, CCK8 assay, immunofluorescence (IHC) staining assay and quantitative real-time PCR. The thermal withdrawal latency (TWL) and edema ratio (ER) were performed to evaluate the analgesia of CB/Lid-n using a plantar inflammation model. A series of histological staining, including immunohistochemistry (IL-6, IL-10, TGF-β and Navi1.7) and TUNEL were conducted to reveal the underlying mechanism of anti-tumor effect of CB/Lid-n on a VX2-tumor bearing model. Results Lid was successfully loaded onto the surface of CalliSpheres® bead, and the average diameter of CalliSpheres® bead increased along with the dosage of Lid. CB/Lid-n exhibited desirable drug-loading ratio, drug-embedding ratio, and sustained drug-release capability. CB/Lid-n had mild toxicity towards L929 cells, while triggered no obvious hemolysis. Furthermore, CB/Lid-n could improve the carrageenan-induced inflammation response micro-environment in vivo and in vitro. We found that CB/Lid-10 could selectively kill tumor by blocking blood supply, inhibiting cell proliferation, and promoting cell apoptosis. CB/Lid-10 could also release Lid to relieve post-operative pain, mainly by remodeling the harsh inflammation micro-environment (IME). Conclusions In summary, CB/Lid-10 has relatively good biocompatibility and bioactivity, and it can serve as a promising candidate for painless transcatheter arterial embolization.

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Gabapentinoids and Risk of Hip Fracture

Leung,

Turner,

Marquina

et al. 2024

JAMA Netw Open

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ImportanceThe increased use of gabapentinoids has been most pronounced in older people who are also susceptible to hip fractures.ObjectiveTo investigate the overall association between gabapentinoids and the risk of hip fractures and the stratified association across age groups, frailty status, and history of chronic kidney disease.Design, Setting, and ParticipantsThis was a case-case-time-control study in patients hospitalized for hip fracture in Victoria, Australia, between March 1, 2013, and June 30, 2018, with at least 1 prescription for a gabapentinoid before fracture. Conditional logistic regression was used to estimate the odds ratio (OR) and 95% CI for gabapentinoid dispensing in the index (1-60 days prefracture) compared with the reference (121-180 days prefracture) period. To adjust for the underlying time trend in gabapentinoid use, each index case was matched with up to 5 controls, selected from future cases of the same age and sex. Subgroup analyses were conducted in subgroups with or without chronic kidney disease (CKD), frailty scores less than 5, and frailty scores 5 and above. Frailty was computed using the Hospital Frailty Risk Score (HFRS). Data were analyzed from November 2023 to April 2024.ExposureGabapentinoids (pregabalin or gabapentin).Main Outcome and MeasureHip fracture.ResultsOf 28 293 patients hospitalized for hip fractures, 2946 (1752 [59.5%] aged ≥80 years; 2099 [71.2%] female) were dispensed a gabapentinoid before hip fracture. Gabapentinoid dispensing was associated with increased odds of hip fractures (OR, 1.96; 95% CI, 1.66-2.32). After adjusting for the exposure-time trend and concomitant use of other central nervous system medications, the odds of hip fractures remained elevated (OR, 1.30; 95% CI, 1.07-1.57). The association between gabapentinoid dispensing and hip fracture was higher in patients with HFRS 5 and above (OR, 1.75; 95% CI, 1.31-2.33) and CKD (OR, 2.41; 95% CI, 1.65-3.52).Conclusions and relevanceIn this case-case-time-control study of Australian residents hospitalized for hip fracture, gabapentinoid use was associated with an increased risk of hip fractures, especially in patients who were frail or had chronic kidney disease. In addition to the known risk associated with kidney impairment, frailty status may be an important risk factor when considering use of gabapentinoids.

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Analgesic use and associated adverse events in patients with chronic kidney disease: a systematic review and meta-analysis

Cited by 9 publications

References 89 publications

Literature review: are NSAIDs harmful and is acetaminophen well tolerated?

Literature review: are NSAIDs harmful and is acetaminophen well tolerated?

One-step fabrication of lidocaine/CalliSpheres® composites for painless transcatheter arterial embolization

Gabapentinoids and Risk of Hip Fracture

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