Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study

Abstract

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) should be avoided among chronic kidney disease (CKD) patients. Till now, limited data are available on NSAID use in Egypt, and we aimed to study the prevalence and pattern of NSAID use among CKD patients.MethodsA cross-sectional study was done among 350 CKD adult patients presented to the Main Alexandria University Hospital. Those with end-stage renal disease and diagnosed with acute renal injury and pregnant women were excluded. Demographic and clinical data were collected by interviewing eligible patients. Data about the pattern, history of drug-drug interactions, and knowledge about the NSAID side effects were also gathered.ResultsOf the enrolled patients, 57.1% were hypertensive, 46% were diabetics, 28% had osteoarthritis, and 18.3% had cardiovascular disease. CKD stages were 3.7%, 40.3%, and 56% in stages 2, 3, and 4, respectively. Almost two thirds (65.7%) were NSAID users. Among them, 82.6% were regular users. Headache was the most reported (68.7%) reason of use. The use of drugs which may have drug-drug interaction with the NSAIDs (as diuretics or renin-angiotensin-aldosterone system inhibitors) was reported in 36%. In multiple logistic regression, the odds of NSAID use decreased by 4% (odds ratio (OR) = 0.96, 95% confidence interval (CI) 0.93–0.99, p = 0.01) for every year increase in the patient’s age and decreased by 3% (OR = 0.97, 95% CI 0.95–0.99, p = 0.01) for every 1 ml/min/1.73 m2 increase in glomerular filtration rate.ConclusionDespite the hazards of NSAID use on the kidney, still high proportion of CKD patients are using them for a long period and they are simultaneously using other drugs with possible drug-drug interactions. This study provided important information that would decrease the gap in knowledge about the use of NSAID in Egypt. It is recommended that NSAIDs should be used with caution among CKD patients and patients should be advised about its adverse health consequences.

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

“…Specifically, acetylsalicylic acid was used in these patients as a platelet aggregation inhibitor. A higher use of acetylsalicylic acid in patients with CKD was observed in other studies (Ingrasciotta et al, 2014;Abd ElHafeez et al, 2019;Okoro and Farate, 2019;Barbieri et al, 2020). Patients mostly treated with low-dose acetylsalicylic acid were those with a registered diagnosis of CKD.…”

Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

“…Furthermore, acetylsalicylic acid was the most inappropriately prescribed medication of all contraindicated prescriptions followed by diclofenac, etoricoxib, and metformin. A higher use of acetylsalicylic acid, diclofenac, and coxib in patients with CKD was observed in other studies [20,23,37]. It is well known that different drugs, including NSAIDs, have a crucial role in the occurrence of nephrotoxic effects induced by the decrease in GFR values and vasodilatation.…”

<p>Practice Advisory on the Appropriate Use of NSAIDs in Primary Care</p>

“…62,85 Risk factors include older age, renal impairment, heart failure, liver disease, diabetes mellitus (DM), and concurrent prescription with antihypertensive drugs (eg, diuretics, renin-angiotensin system inhibitors). 62,86,87 Again, mechanisms of NSAID-induced kidney damage relate to inhibition of prostaglandin synthesis and are dose-and duration-dependent. 80,81 Low levels of COX-2 are constitutively expressed in the macula densa, with COX-2 inhibition leading to a reduction in renal blood flow and resulting functional impairment.…”