title: Selective cyclooxygenase-2 inhibitor use and progression of renal function in patients with chronic kidney disease: a single-center retrospective cohort study.
abstract: BACKGROUND
  The use of selective COX-2 (sCOX-2) inhibitors with acute kidney injury, salt water retention, and cardiovascular events have been correlated in subjects with normal kidney function, but sCOX-2 inhibitor use concerning the progression of chronic kidney disease (CKD) remains uncertain.
  
  
  OBJECTIVE
  To determine the progression of renal function and electrolyte abnormalities among CKD patients after using sCOX-2 inhibitors during short- and long-term periods.
  
  
  METHODS
  The study employed a retrospective cohort design comprising all types of CKD patients with and without sCOX-2 inhibitors (celecoxib and etoricoxib). Data collected included medical data, estimated glomerular filtration rate (eGFR), and serum electrolytes at 3 and 6 months between January 2009 and January 2014. Subjects attended the outpatient clinic and were then followed up until discontinuation of the drugs at years 1 and 2 until May 2016.
  
  
  RESULTS
  Ninety-two CKD patients on sCOX-2 inhibitors and 92 CKD patients without sCOX-2 inhibitors were included. The sCOX-2 inhibitor group showed more decline in eGFR than the control group at 3 and 6 months of follow-up (-8.27±9.75 vs -1.64±6.05 mL/min/1.73 m2,P<0.001 and -12.36±6.48 vs -4.31±5.11 mL/min/1.73 m2,P=0.001, respectively) and at 1 and 2 years of follow-up after subjects discontinued sCOX-2 (-6.84±10.34 vs -1.61±8.93 mL/min/1.73 m2,P=0.004 and -10.26±10.19 vs -5.12±8.61 mL/min/1.73 m2,P=0.005, respectively). In addition, the sCOX-2 inhibitor group had significantly more increased serum potassium during the study follow-up than the control group.
  
  
  CONCLUSIONS
  The sCOX-2 inhibitors are associated with an increased risk for rapid eGFR decline and hyperkalemia in both the short term and in the long term after sCOX-2 inhibitors were terminated in the setting of a community-based CKD population. For CKD patients, these results suggest that sCOX-2 inhibitors should be closely monitored and chronic exposure to any sCOX-2 inhibitors should be avoided.
authors.affiliation: Department of Military and Community Medicine, Phramongkutklao College of Medicine; Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
authors.forename: Wisit
authors.initials: W
authors.lastname: Kaewput
authors.affiliation: Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
authors.forename: Preedee
authors.initials: P
authors.lastname: Disorn
authors.affiliation: Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
authors.forename: Bancha
authors.initials: B
authors.lastname: Satirapoj
keywords: chronic kidney disease; long-term renal progression; selective cyclooxygenase-2 inhibitor