NSAID prescriptions in kidney transplant recipients

Abstract

Background: Guidelines recommend that non-steroidal anti-inflammatory drugs (NSAIDs) be avoided in kidney transplant recipients due to potential nephrotoxicity.It is unclear whether physicians are following these recommendations. Methods:We conducted a retrospective cohort study of adult kidney transplant recipients from 2008 to 2017 in Alberta, Canada. We determined the frequency and prescriber of NSAID prescriptions, the proportion with serum creatinine and potassium testing post-fill, and the incidence of acute kidney injury (AKI, serum creatinine increase of ≥50% or ≥26.5 μmol/L from baseline) and hyperkalemia (potassium ≥5.5 mmol/L) within 14 and 30 days.Results: Of the 1730 kidney transplant recipients, 189 (11%) had at least one NSAID prescription over a median follow-up of 5 years (IQR 2-9) (280 unique prescriptions).The majority were prescribed by family physicians (67%). Approximately 25% and 50% of prescriptions had serum creatinine and potassium testing within 14 and 30 days, respectively. Of those with lab measurements within 14 days, 13% of prescriptions were associated with AKI and 5% had hyperkalemia.Conclusions: Contrary to guidelines, one in 10 kidney transplant recipients are prescribed an NSAID, and most do not get follow-up testing of graft function and hyperkalemia. These findings call for improved education of patients and primary care providers.

Perioperative management of kidney transplantation in China: A national survey in 2021

“…Twenty-one Chinese centres use NSAIDs in the PCIA; however, it is recommended to be avoided in kidney transplant recipients because of potential nephrotoxicity [ 30 ]. If NSAIDs are used, follow-up testing of graft function and hyperkalemia may be needed [ 31 ] since the postoperative use of NSAIDs is associated with a significant increase in the risk of AKI [ 32 ]. Regional analgesia should be considered for postoperative analgesia, as it offers significant postoperative pain control, reduced postoperative opioid, and less antiemetic requirements.…”

Proton Pump Inhibitors Use in Kidney Transplant Recipients: A Population-Based Study

“…These databases have been previously used for research on health services and health outcomes in the kidney transplant recipient population. 9 - 13 …”

Follow-up Care of Critically Ill Patients With Acute Kidney Injury: A Cohort Study

“… 10 These databases have been used extensively for similar research on health services and outcomes in Alberta. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 We followed guidelines for observational studies ( Table S1 ), 19 , 20 and the protocol was approved by the research ethics boards at the University of Alberta and the University of Calgary, with a waiver of patient consent granted.…”