Article

Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation: a nationwide study

Department of Cardiology, Copenhagen University Hospital, Gentofte, Hellerup, Denmark.
Pharmacoepidemiology and Drug Safety (Impact Factor: 3.17). 04/2012; 21(4):428-34. DOI: 10.1002/pds.3227
Source: PubMed

ABSTRACT Nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with severe renal complications, including acute renal failure, reduced glomerular filtration rate and interstitial nephritis. Caution against NSAIDs is therefore recommended in advanced chronic kidney disease. In this study, we examined NSAID use, aetiology and comorbidity among a national cohort of patients before the initiation of chronic renal replacement therapy (RRT).
Patients initiated on chronic RRT in the period 1997-2006 were identified in the Danish National Registry on Regular Dialysis and Transplantation, including etiological diagnosis. The use of NSAID before the start of RRT was studied by linkage to the National Prescription Register and comorbidity by linkage to the National Patient Registry.
A total of 6663 patients were included in the study, and 2407 patients (36.1%) were prescribed NSAID in the 3 years before the start of RRT. These patients were older (mean age = 63.0 vs 61.4 years) and had a significantly higher degree of comorbidity (Charlson score = 2.85 vs 2.61, p < 0.05) compared with patients not treated with NSAIDs. In the 3 years leading up to RRT, the number of patients treated with NSAID each year and the cumulated median length of treatment including all NSAIDs were stable at approximately 20% and 40 days, respectively.
In this study of a nationwide group of patients, we observed a widespread use of NSAID with an unaffected high annual incidence in the 3 years leading up to the initiation of RRT.

0 Followers
 · 
122 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Due to the widespread use of anti-inflammatory drugs in clinical practice in various clinical settings and the ease of issue without prescription, many patients are exposed to risks associated to these drugs and particularly to drug interactions. The purpose of this review is to deal with the safety parameters of main anti-inflammatory agents, especially NSAIDs including coxibs, and the different drug interactions with a special emphasis on clinical relevance and recommendations in current practice. We will present consecutively different interactions between anti-inflammatory agents and frequently used drugs. In particular, association between anti-inflammatory drugs and anticoagulants could induce severe complications. Haemorrhagic complications and particularly gastrointestinal bleeding will be discussed together with potential treatment adjustment and likely benefits of new therapies such as specific antagonist of active factor X or II. On the other hand, anti-hypertensive therapies, non specific cytochrome dysregulations and particularly the question of anti-arrhythmic drugs, the problem of proton pump inhibitors and specific clinical settings such as drug interactions in elderly are discussed.
    Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry (Formerly Cu rrent Medicinal Chemistry - Anti-Inflammatory and Anti-Allergy Agents) 12/2012; DOI:10.2174/1871523011312010006
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents' characteristics. OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents' and facilities' characteristics. METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents' characteristics associated with PIP. RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 % (95 % CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 %). The most often prescribed PIP were Prothipendyl (25.9 % residents), Lorazepam (14.5 %) and Diclofenac (6.1 %). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents. CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.
    Wiener klinische Wochenschrift 03/2013; 125(7-8). DOI:10.1007/s00508-013-0342-2 · 0.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Full text: http://www.tandfonline.com/eprint/6WNS9HjT5iaSAFY6hDXs/full Participating in competitive sport increases the risk for injuries and musculoskeletal pain among adolescent athletes. There is also evidence that the use of prescription drugs has increased among sport club athletes. The purpose of this study was to evaluate the use of painkillers among young male ice hockey players (IHP) in comparison to schoolboys (controls) and its relation to the prevalence of musculoskeletal pain and problems during activities and sleeping. Information was gathered through a questionnaire, completed by 121 IHP and compared to the responses of 618 age-matched controls. Results showed that monthly existing pain was at 82% for IHP, and 72% for controls, though IHP had statistically more musculoskeletal pain in their lower limbs (56% versus 44%), lower back (54% versus 35%), and buttocks (26% versus 11%). There were no group differences in the neck, upper back, upper limb, or chest areas. The disability index was statistically similar for both groups, as musculoskeletal pain causing difficulties in daily activities and sleeping was reported by a minority of subjects. Despite this similarity, IHP used more painkillers than controls (18% versus 10%). Further nuanced research is encouraged to compare athletes and non-athletes in relation to painkillers.
    04/2014; 2(1):448-454. DOI:10.1080/21642850.2014.884463