NSAID use and progression of chronic kidney disease.
OBJECTIVE
The effects of nonselective and selective cyclooxygenase-2 specific (COX-2) nonsteroidal anti-inflammatory drug (NSAID) use on the progression of chronic kidney disease (CKD) is uncertain. Due to the high prevalence of both CKD and NSAID use in older adults, we sought to determine the association between NSAID use and the progression of CKD in an elderly community-based cohort.


METHODS
All subjects > or =66 years of age who had at least one serum creatinine measurement in 2 time periods (July-December, 2001 and July-December, 2003) were included. Multiple logistic regression analyses, including covariates for age, sex, baseline estimated glomerular filtration rate (eGFR), diabetes, and comorbidity were used to explore the associations of NSAID use on the primary (decrease in eGFR of > or =15 mL/min/1.73) and secondary (mean change in eGFR) outcomes.


RESULTS
A total of 10,184 subjects (mean age 76 years; 57% female) were followed for a median of 2.75 years. High-dose NSAID users (upper decile of cumulative NSAID exposure) experienced a 26% increased risk for the primary outcome (odds ratio [OR] 1.26, 95% confidence interval [CI], 1.04-1.53). A linear association between cumulative NSAID dose and change in mean GFR also was seen. No risk differential was identified between selective and nonselective NSAID users.


CONCLUSIONS
High cumulative NSAID exposure is associated with an increased risk for rapid CKD progression in the setting of a community-based elderly population. For older adult patients with CKD, these results suggest that nonselective NSAIDs and selective COX-2 inhibitors should be used cautiously and chronic exposure to any NSAID should be avoided.
Gooch
Katherine
K
Institute of Health Economics, Edmonton, Alberta, Canada.
Culleton
Bruce F
BF
Manns
Braden J
BJ
Zhang
Jianguo
J
Alfonso
Helman
H
Tonelli
Marcello
M
Frank
Cy
C
Klarenbach
Scott
S
Hemmelgarn
Brenda R
BR
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011336:Probability; D012307:Risk Factors; D012720:Severity of Illness Index
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003404:Creatinine