title: Analgesia dose prescribing and estimated glomerular filtration rate decline: a general practice database linkage cohort study.
abstract: OBJECTIVE
  We aimed to quantify the short-term effect of non-steroidal anti-inflammatory drugs (NSAIDs), aspirin and paracetamol analgesia dose prescribing on estimated glomerular filtration rate (eGFR) decline in the general practice population.
  
  
  METHODS
  A population-based longitudinal clinical data linkage cohort study.
  
  
  METHODS
  Two large general practices in North Staffordshire, UK.
  
  
  METHODS
  Patients aged 40 years and over with ≥2 eGFR measurements spaced ≥90 days apart between 1 January 2009 and 31 December 2010 were selected.
  
  
  METHODS
  Using WHO Defined Daily Dose standardised cumulative analgesia prescribing, patients were categorised into non-user, normal and high-dose groups.
  
  
  METHODS
  The primary outcome was defined as a >5 mL/min/1.73 m(2)/year eGFR decrease between the first and last eGFR. Logistic regression analyses were used to estimate risk, adjusting for sociodemographics, comorbidity, baseline chronic kidney disease (CKD) status, renin-angiotensin-system inhibitors and other analgesia prescribing.
  
  
  RESULTS
  There were 4145 patients (mean age 66 years, 55% female) with an analgesia prescribing prevalence of 17.2% for NSAIDs, 39% for aspirin and 22% for paracetamol and stage 3-5 CKD prevalence was 16.1% (n=667). Normal or high-dose NSAID and paracetamol prescribing was not significantly associated with eGFR decline. High-dose aspirin prescribing was associated with a reduced risk of eGFR decline in patients with a baseline (first) eGFR ≥60 mL/min/1.73 m(2); OR=0.52 (95% CI 0.35 to 0.77).
  
  
  CONCLUSIONS
  NSAID, aspirin and paracetamol prescribing over 2 years did not significantly affect eGFR decline with a reduced risk of eGFR decline in high-dose aspirin users with well-preserved renal function. However, the long-term effects of analgesia use on eGFR decline remain to be determined.
authors.affiliation: Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University, Keele, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Nderitu
authors.affiliation: Public Health, Epidemiology and Biostatistics, NIHR Horizon Scanning Centre, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Doos
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.
authors.forename: Vicky Y
authors.initials: VY
authors.lastname: Strauss
authors.affiliation: Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University, Keele, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lambie
authors.affiliation: Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University, Keele, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Davies
authors.affiliation: Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University, Keele, UK.
authors.forename: Umesh T
authors.initials: UT
authors.lastname: Kadam
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D058006:General Practice; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D001241:Aspirin
keywords: EPIDEMIOLOGY; PRIMARY CARE