title: Increased Risk of End-Stage Renal Disease (ESRD) Requiring Chronic Dialysis is Associated With Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Nationwide Case-Crossover Study.
abstract: It is known that many medical adverse events can be caused by nonsteroidal anti-inflammatory drugs (NSAIDs); however, epidemiologic evidence has not granted an affirmative relationship between NSAID use and the risk of end-stage renal disease (ESRD). We aimed to investigate the relationship in a Chinese population between short-term NSAID use and development of ESRD requiring chronic dialysis. A retrospective case-crossover design was used in this study. Using the Taiwanese National Health Insurance database, we identified 109,400 incident chronic ESRD patients with dialysis initiation from 1998 to 2009. For each patient, we defined the case period as 1 to 14 days and the control period as 105 to 118 days, respectively, before the first dialysis date. The washout period was 90 days between the case and control period. Detailed information about NSAID use was compared between the case and control periods. We calculated odds ratios (ORs) and their 95% confidence intervals (CIs) using a conditional logistic regression model. NSAID use was found to be a significant risk factor associated with dialysis commencement. The adjusted OR was 2.73 (95% CI: 2.62-2.84) for nonselective NSAIDs and 2.17 (95% CI: 1.83-2.57) for celecoxib. The OR reached 3.05 for the use of acetic acid derivatives. Compared with the oral forms, significantly higher risks were seen in parenteral NSAID use (OR: 8.66, 95% CI: 6.12-20.19). NSAIDs should be prescribed with caution, especially for those in ESRD high-risk groups.
authors.affiliation: From the Institute of Population Health Sciences, National Health Research Institutes, Zhunan (Y-KC, J-SL, C-CH); Department of Health Services Administration, China Medical University, Taichung (C-CH); Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi (Y-HH); Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan (Y-HH); Institutes of Physiology and Clinical Medicine, National Yang-Ming University (D-CT); Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital (D-CT); and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan (D-CT, C-CH).
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Chang
authors.forename: Jia-Sin
authors.initials: JS
authors.lastname: Liu
authors.forename: Yueh-Han
authors.initials: YH
authors.lastname: Hsu
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D018592:Cross-Over Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal