Association of Individual Non-Steroidal Anti-Inflammatory Drugs and Chronic Kidney Disease: A Population-Based Case Control Study

Abstract

BackgroundNon-steroidal anti-inflammatory agents (NSAIDs) are known to be associated with renal damage. No clear evidence exists regarding differential risk of chronic kidney disease (CKD), specifically, across various NSAIDs.AimThe aim of this population-based case-control study was to evaluate the association between use of individual NSAIDs and risk of CKD in a general population of Southern Italy.MethodsA nested case-control study was carried out using the general practice Arianna database, identifying incident CKD patients as cases and matched controls from 2006 to 2011. The date of first CKD diagnosis was defined as the index date (ID). Conditional logistic regressions were performed to estimate the risk of CKD associated with NSAIDs by class and individual drugs as compared to non-use during different time windows (within one year, six or three months prior to ID), with the latter being defined as current users. Among current users, the effect of cumulative exposure to these drugs was evaluated.ResultsOverall, 1,989 CKD cases and 7,906 matched controls were identified. A statistically significant increase in the risk of CKD was found for current users of oxicams (adjusted OR: 1.68; 95% CI: 1.15-2.44) and concerning individual compounds, for ketorolac (adj. OR: 2.54; 95% CI: 1.45-4.44), meloxicam (adj. OR: 1.98; 95% CI: 1.01-3.87) and piroxicam (adj. OR: 1.95; 95% CI: 1.19-3.21).ConclusionsThe risk of CKD varies across individual NSAIDs. Increased risk has been found for ketorolac, which may precipitate subclinical CKD through acute renal damage, and long-term exposure to oxicams, especially meloxicam and piroxicam.

Use of anti-inflammatory analgesics in sickle-cell disease

“…18 Large epidemiological studies of healthy individuals have not consistently demonstrated an association between chronic non-aspirin NSAID use and CKD. 19–22 In contrast, high-risk individuals, such as the elderly, have a more rapid decline in estimated glomerular filtration rate (eGFR) after exposure to high doses of non-aspirin NSAIDs, 23 which was supported by other small cohort and case-control studies. 24 Non-aspirin NSAIDs can also reduce sodium excretion, increase intravascular volume, and increase systolic blood pressure by approximately 5 mmHg on average in a meta-analysis.…”

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

“…Regular ibuprofen users in the NHANES had no change in renal function compared with controls. 29) There was also no link demonstrated in the case control study by Ibanez et al34) nor the large 14 year prospective study by Rexrode et al32) In a recent Italian case control study of approximately 2,000 patients with CKD and nearly 8,000 matched controls, no association was identified between high intake of NSAIDs and renal insufficiency (OR, 0.94; 95% CI, 0.84 to 1.05) 39). A multicenter European report of 4,529 dialysis patients and controls did not find abuse of any common non-phenacetin analgesics to increase the risk of ESRF (OR, 1.02; 95% CI, 0.81 to 1.28) 40).…”

Use of Nonsteroidal Anti-Inflammatory Drugs for the Treatment of Axial Spondyloarthritis, Including Ankylosing Spondylitis, Monitoring Their Efficacy and Safety (Draft Guidelines of the Expert Spondyloarthritis Diagnosis and Treatment Group)

“…Изве-стно, что при ревматических заболеваниях имеется по-вышенный риск развития осложнений со стороны ЖКТ, ССС и почек, в том числе и вне зависимости от получаемого лечения [39][40][41][42][43][44][45][46][47]. Существующие на дан-ный момент шкалы не способны учитывать вклад вос-паления в повышение соответствующих рисков.…”