title: Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review.
abstract: BACKGROUND
  Non-steroidal anti-inflammatory drugs (NSAIDs) are widely regarded as one risk factor, which influences chronic kidney disease (CKD) progression. However, previous literature reviews have not quantified the risk in moderate to severe CKD patients.
  
  
  OBJECTIVE
  To estimate the strength of association between chronic NSAID use and CKD progression.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of observational general practice or population studies featuring patients aged 45 years and over. The electronic databases searched were MEDLINE, EMBASE, Cochrane, AMED, BNI and CINAHL until September 2011 without date or language restrictions. Searches included the reference lists of relevant identified studies, WEB of KNOWLEDGE, openSIGLE, specific journals, the British Library and expert networks. For relevant studies, random effects meta-analysis was used to estimate the association between NSAID use and accelerated CKD progression (estimated glomerular filtration rate decline ≥ 15 ml/min/1.73 m2).
  
  
  RESULTS
  From a possible 768 articles, after screening and selection, seven studies were identified (5 cohort, 1 case-control and 1 cross-sectional) and three were included in the meta-analysis. Regular-dose NSAID use did not significantly affect the risk of accelerated CKD progression; pooled odds ratio (OR) = 0.96 (95%CI: 0.86-1.07), but high-dose NSAID use significantly increased the risk of accelerated CKD progression; pooled OR = 1.26 (95%CI: 1.06-1.50).
  
  
  CONCLUSIONS
  The avoidance of NSAIDs in the medium term is unnecessary in patients with moderate to severe CKD, if not otherwise contraindicated. As the definition of high-dose of NSAID use remains unclear, the lowest effective dose of NSAIDs should be prescribed where indicated.
authors.affiliation: Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University, Keele, UK. p.nderitu@istm.keele.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Nderitu
authors.forename: Lucy
authors.initials: L
authors.lastname: Doos
authors.forename: Peter W
authors.initials: PW
authors.lastname: Jones
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Davies
authors.forename: Umesh T
authors.initials: UT
authors.lastname: Kadam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000494:pharmacology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced*; D012306:Risk
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Disease progression; general practice; glomerular filtration rate; kidney disease; non-steroidal anti-inflammatory agents; systematic review.