title: Estimated GFR reporting is associated with decreased nonsteroidal anti-inflammatory drug prescribing and increased renal function.
abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used; however, they are also nephrotoxic with both acute and chronic effects on kidney function. Here we determined NSAID prescribing before and after estimated GFR (eGFR) reporting and evaluate renal function in patients who used NSAIDs but stopped these after their first eGFR report. A population-based longitudinal analysis using a record-linkage database was conducted with the GFR estimated using the four-variable equation from the MDRD study and analyzed by trend test, paired t-test, and logistic regression modeling. Prescriptions for NSAIDs significantly decreased from 39,459 to 35,415 after implementation of eGFR reporting from the second quarter of 2005 compared with the first quarter of 2007. Reporting eGFR was associated with reduced NSAID prescriptions (adjusted odds ratio, 0.78). NSAID prescription rates in the 6 months before April 2006 were 18.8, 15.4, and 7.0% in patients with CKD stages 3, 4, and 5 and 15.5, 10.7, and 6.3%, respectively, after eGFR reporting commenced. In patients who stopped NSAID treatment, eGFR significantly increased from 45.9 to 46.9, 23.9 to 27.1, and 12.4 to 26.4 ml/min per 1.73 m(2) in 1340 stage 3 patients, 162 stage 4 patients, and 9 stage 5 patients, respectively. Thus, NSAID prescribing decreased after the implementation of eGFR reporting, and there were significant improvements in estimated renal function in patients who stopped taking NSAIDs. Hence, eGFR reporting may result in safer prescribing.
authors.affiliation: Department of Practice and Policy, UCL School of Pharmacy, London, UK. l.wei@ucl.ac.uk
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.forename: Thomas M
authors.initials: TM
authors.lastname: MacDonald
authors.forename: Claudine
authors.initials: C
authors.lastname: Jennings
authors.forename: Xia
authors.initials: X
authors.lastname: Sheng
authors.forename: Robert W
authors.initials: RW
authors.lastname: Flynn
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Murphy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D011307:Drug Prescriptions; D004363:Drug Utilization; D017723:Drug Utilization Review; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D008954:Models, Biological; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D020127:Recovery of Function; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal