Non-steroidal anti-inflammatory drugs and risk of acute adverse renal outcomes in diabetes and diabetic kidney disease

Abstract

BACKGROUND: Individuals with diabetes mellitus (DM) may be susceptible to non-steroidal anti-inflammatory drug (NSAID) – induced acute kidney injury (AKI) but data on NSAID-related adverse renal events is sparse. We aimed to evaluate the risk of acute kidney injury and/or hyperkalemia after systemic NSAID among individuals with DM and diabetic chronic kidney disease (CKD). METHODS: Retrospective cohort study of 3896 adults with DM with incident prescriptions between July 2015 and December 2017 from Singapore General Hospital and SingHealth Polyclinics. Laboratory, hospitalization and medication data were retrieved from electronic medical records. The primary outcome was the incidence of AKI and/ or hyperkalemia within 30 days after prescription. RESULTS: AKI and/or hyperkalemia occurred in 13.5% of all DM and 15.8% of diabetic CKD. The association between systemic NSAID >14 days and 30-day risk of AKI and/or hyperkalemia failed to reach statistical significance in unselected DM (adjusted OR 1.62, 95% CI 0.99–2.65, p = 0.05) and diabetic CKD (adjusted OR 0.64, 95% CI 0.15–2.82, p = 0.64), but the odds of AKI and/or hyperkalemia were markedly and significantly increased when NSAID was prescribed with renin-angiotensin-aldosterone system (RAAS) blocker (adjusted OR 4.17, 95% CI 1.74–9.98, p = 0.001) or diuretic (adjusted OR 3.31, 95% CI 1.09–10.08, p = 0.04) and in the absence of diabetic CKD (adjusted OR 1.98, 95% CI 1.16–3.36, p = 0.01). CONCLUSION: NSAID prescription >14 days in individuals with DM with concurrent RAAS blockers or diuretics was associated with higher 30-day risk of AKI and/or hyperkalemia.

Association Between Iron Metabolism and Acute Kidney Injury in Critically Ill Patients With Diabetes

“…In this study, the clinical data from MIMIC-III database were retrospectively analyzed, and the results showed that the critically ill patients with diabetes complicated with AKI were more likely to have abnormal iron metabolism indicators than those in non-AKI group, and the increase of SF was closely related to AKI and all-cause death in critical patients with diabetes. Previous studies have shown that the predictors for AKI in diabetic patients were advanced age, CHF, CKD, hypertension, smoking, alcohol consumption, diabetic nephropathy, infection, aminoglycosides, diabetic ketoacidosis, non-steroidal anti-inflammatory drugs, long course of diabetes, diuretics, beta blockers, and delay of follow-up (14,(24)(25)(26). However, whether abnormal iron metabolism is related to the occurrence of AKI in diabetic patients seems to be unproven in previous studies.…”

Cost‐effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore

“…In the base case analysis, we assumed that 40% of eligible patients are on RAASi, as is the case for SingHealth patients. 27,28 Following guidelines by Singapore Agency For Care Effectiveness (ACE), 29 we applied an annual 3% discount rate when accumulating lifetime cost and QALYs beyond the first year. We simulated a cohort of 30 000 patients for each run to ensure model convergence.…”