The relationship between long-term use of nonsteroidal anti-inflammatory drugs and kidney function in patients with ankylosing spondylitis

Abstract

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for ankylosing spondylitis (AS), their effect on kidney function remains unclear. This longitudinal study investigated the correlation between long-term NSAID use and kidney function in patients with AS using electronic medical records. Methods: The electronic medical records of 1,280 patients with AS collected from a single center between January 2001 and December 2018 were reviewed. The Assessment of Spondyloarthritis International Society (ASAS) NSAID Intake Score was used to determine the cumulative dose of all NSAIDs prescribed for a different time intervals. Each ASAS NSAID Intake Score was obtained for intervals of 6 months, 1 year, 2 years, 3 years, 5 years, and 10 years. The correlation between the ASAS NSAID Intake Score and final estimated glomerular filtration rate (eGFR) for each interval was investigated.

Are nonsteroidal anti-inflammatory drugs safe for the kidney in ankylosing spondylitis?

“…A recent study by Koo et al [4] To interpret the results of this study, some points need to be considered. First, the finding that there was no clinically significant deterioration of renal function in patients treated with higher doses of NSAIDs might be due to channeling bias, where patients with better renal function and less comorbidities may have been prescribed more NSAIDs than those with poorer renal function and more comorbidities.…”

“…A recent study by Koo et al [ 4 ] published in the Journal of Rheumatic Diseases investigated the relationship between long-term use of NSAIDs and renal function using the electronic medical records of 1,280 patients with AS. NSAID exposure was determined by the Assessment of Spondyloarthritis International Society (ASAS) NSAID Intake Score for time intervals of 6 months, 1 year, 2 years, 3 years, 5 years, and 10 years.…”

“…Second, considering the young age of the study population, relatively few patients experienced decline in renal function. In the ASAS-comorbidities in spondyloarthritis (COMOSPA) cohort, the prevalence of renal impairment defined as an eGFR <60 mL/min/1.73 m 2 was 5.2% [ 6 ], which was higher than that in a study by Koo et al [ 4 ]. The mean age was 45.3 years in the ASAS-COMOSPA cohort, while much younger patients (mean age, 30.2 years) were included in the present study [ 4 ].…”

“…In the ASAS-comorbidities in spondyloarthritis (COMOSPA) cohort, the prevalence of renal impairment defined as an eGFR <60 mL/min/1.73 m 2 was 5.2% [ 6 ], which was higher than that in a study by Koo et al [ 4 ]. The mean age was 45.3 years in the ASAS-COMOSPA cohort, while much younger patients (mean age, 30.2 years) were included in the present study [ 4 ]. Age is a strong risk factor for renal impairment in the general population, as well as in patients with AS.…”

“…Current NSAID intake was associated with renal impairment in univariate analysis, but the association disappeared after adjustment for confounding factors including age [ 6 ]. In Supplementary Table 1 of Koo et al [ 4 ], the NSAID Intake Score increased and eGFR decreased as age increases from 18~40 years to 60~80 years, suggesting that age is a more important factor in the decline of eGFR. Third, the risk of decline in renal function may differ in subgroups of baseline eGFR and comorbidities.…”