NSAID Use and Progression of Chronic Kidney Disease

Gooch, Katherine; Culleton, Bruce F.; Manns, Braden; Zhang, Jianguo; Alfonso, Helman; Tonelli, Marcello; Frank, Cy; Klarenbach, Scott; Hemmelgarn, Brenda R.

doi:10.1016/j.amjmed.2006.02.015

Cited by 264 publications

(216 citation statements)

References 19 publications

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“…Large studies have shown that achieving a hemoglobin A1c level#7% reduces proteinuria and the risk of CKD (33,34). Limited evidence exists for smoking cessation (35), lipid control (36), and the avoidance of nephrotoxic agents (37). However, lipid control and smoking cessation seem prudent in light of the high incidence of cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a CKD Checklist for Primary Care Providers

Mendu

Schneider

Aizer³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives CKD is associated with significant morbidity, mortality, and financial burden. Practice guidelines outlining CKD management exist, but there is limited application of these guidelines. Interventions to improve CKD guideline adherence have been limited. This study evaluated a new CKD checklist (a tool outlining management guidelines for CKD) to determine whether implementation in an academic primary care clinic improved adherence to guidelines.Design, setting, participants, & measurements During a 1-year period (August 2012-August 2013), a prospective study was conducted among 13 primary care providers (PCPs), four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD stages 1-4. All providers received education regarding CKD guidelines. The intervention and control groups consisted of 105 and 263 patients, respectively. Adherence to CKD management guidelines was measured.Results A random-effects logistic regression analysis was performed to account for intra-group correlation by PCP assignment and adjusted for age and CKD stage. CKD care improved among patients whose PCPs were assigned to the checklist intervention compared with controls. Patients in the CKD checklist group were more likely than controls to have appropriate annual laboratory testing for albuminuria (odds ratio [OR], 7.9; 95% confidence interval [95% CI], 3.6 to 17.2), phosphate (OR, 3.5; 95% CI, 1.5 to 8.3), and parathyroid hormone (OR, 8.1; 95% CI, 4.8 to 13.7) (P,0.001 in all cases). Patients in the CKD checklist group had higher rates of achieving a hemoglobin A1c target,7% (OR, 2.7; 95% CI, 1.4 to 5.1), use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker (OR, 2.1; 95% CI, 1.0 to 4.2), documentation of avoidance of nonsteroidal anti-inflammatory drugs (OR, 41.7; 95% CI, 17.8 to 100.0), and vaccination for annual influenza (OR, 2.1; 95% CI, 1.1 to 4.0) and pneumococcus (OR, 4.7; 95% CI, 2.6 to 8.6) (P,0.001 in all cases).Conclusions Implementation of a CKD checklist significantly improved adherence to CKD management guidelines and delivery of CKD care.

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Section: Discussionmentioning

confidence: 99%

Implementation of a CKD Checklist for Primary Care Providers

Mendu

Schneider

Aizer³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…50,57,75 In human medicine, the role of NSAIDs in chronic kidney disease (CKD) is much less clear. While some studies have suggested that NSAIDs may be a risk factor for developing CKD (so-called 'analgesic nephropathy'), [82][83][84] or in the progression of existing CKD, 85 others have found no evidence of a causal association, 86,87 and the difficulties in interpreting trial data have been highlighted. 88 Where studies have suggested a link between CKD and NSAID use, the risk appears to be low, and may be exacerbated by heavy use of one or more NSAIDs.…”

Section: S P E C I a L A R T I C L E / Isfm/aafp Guidelines On Nsaidsmentioning

confidence: 99%

“…88 Where studies have suggested a link between CKD and NSAID use, the risk appears to be low, and may be exacerbated by heavy use of one or more NSAIDs. 85,88,89 Two retrospective studies evaluated the safety of NSAIDs in a total of 76 older cats, including some cats with stable CKD. In both studies, cats received oral meloxicam (approximately 0.02 mg/kg/day) on a long-term basis for osteoarthritis.…”

Section: S P E C I a L A R T I C L E / Isfm/aafp Guidelines On Nsaidsmentioning

confidence: 99%

ISFM and AAFP Consensus Guidelines: Long-Term use of NSAIDs in Cats

Sparkes

Heiene

Lascelles

et al. 2010

Journal of Feline Medicine and Surgery

104

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NSAIDs and cats Non-steroidal anti-inflammatory drugs (NSAIDs) are an important class of drug in feline medicine, having analgesic, anti-inflammatory and antipyretic activity. While most published data on their use in this species relate to short-term (often perioperative) therapy, there is increasing evidence of the value of these drugs in treating chronic pain in cats (for example, that associated with degenerative joint disease), and some NSAIDs have now become licensed for long-term use in cats in some geographies. Most of our knowledge of therapeutic mechanisms or adverse drug reactions associated with NSAIDs is extrapolated from work in other species, and there is a paucity of published data relating to cats. Guidelines These guidelines have been drawn together by an expert panel, which have reviewed the current literature on long-term NSAID use in cats and other species, and developed guidance on their use based on this information. The aim is to provide practical information for veterinarians to encourage appropriate NSAID therapy whenever cats will benefit from the use of these drugs.

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“…Patients receiving the highest doses of NSAIDs (≥ 90 th percentile) have a 26% increased risk for chronic kidney failure [115]. In contrast, in a study of small-volume diclofenac bolus injections for postsurgical pain (n=971), less than 1% of patients had nausea, dyspepsia, decreased urine output, or acute renal failure [116].…”

Section: Non Steroidal Anti-inflammatory Drugs (Nsaids)mentioning

confidence: 99%

Acute Pain Management in the Emergency Department: Emphasis on NSAIDs

Nalamachu¹

2014

Emergency Medicine

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NSAID Use and Progression of Chronic Kidney Disease

Cited by 264 publications

References 19 publications

Implementation of a CKD Checklist for Primary Care Providers

Implementation of a CKD Checklist for Primary Care Providers

ISFM and AAFP Consensus Guidelines: Long-Term use of NSAIDs in Cats

Acute Pain Management in the Emergency Department: Emphasis on NSAIDs

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