Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

Department of Medicine, University of California, San Francisco, California, USA.
The Annals of Family Medicine (Impact Factor: 5.43). 09/2011; 9(5):423-30. DOI: 10.1370/afm.1302
Source: PubMed


Because avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States.
A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999-2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defined by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥ 30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular filtration rate of 15-59 mL/min/1.73 m(2)). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting.
Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P=.979).
Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.

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    • "The probable explanation for early hyperkalemia resolution was prompt therapeutic interventions with intravenous fluids and stopping NSAIDs. The lower use of NSAIDs causing hyperkalemia in our study (6%) was due to the high prevalence of chronic kidney disease and coronary artery disease in our patients who were less likely to receive NSAIDs [32, 33]. Data to study medication use were recorded in such a way as to reflect the medications the patient was taking immediately prior to the episode of hyperkalemia (36 h). "
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    ABSTRACT: Introduction The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia. Material and methods Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected. Patients with end-stage renal disease on dialysis were excluded. Results Of 15,608 hospitalizations, 451 (2.9%) episodes of hyperkalemia occurred in 408 patients. In patients with hyperkalemia, chronic kidney disease, hypertension, diabetes, coronary artery disease and heart failure were common comorbidities. Acute kidney injury (AKI) and metabolic acidosis were common metabolic abnormalities, and 359 patients (88%) were on at least one drug associated with hyperkalemia. Mean duration to resolution of hyperkalemia was 12 ±9.9 h. Nonsteroidal anti-inflammatory drugs (HR = 1.59), highest potassium level (HR = 0.61), tissue necrosis (HR = 0.61), metabolic acidosis (HR = 0.77), and AKI (HR = 0.77) were significant independent determinants of duration prior to hyperkalemia resolution. Tissue necrosis (OR = 4.55), potassium supplementation (OR = 5.46), metabolic acidosis (OR = 4.84), use of calcium gluconate for treatment of hyperkalemia (OR = 4.62), AKI (OR = 3.89), and prolonged duration of hyperkalemia (OR = 1.06) were significant independent predictors of in-hospital mortality. Conclusions Tissue necrosis, potassium supplementation, metabolic acidosis, calcium gluconate for treatment of hyperkalemia, AKI and prolonged duration of hyperkalemia are independent predictors of in-hospital mortality.
    Full-text · Article · May 2014 · Archives of Medical Science
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    • "As it has been shown, inappropriate NSAID use may cause gastric irritation, ulcer, chronic blood loss, anemia and sodium retention, and renal failure in patients aged over 65. The effectiveness of antihypertensive drugs may be reduced due to nephrotoxicity [2, 24, 25]. Chronic pain has adverse effects on life quality, physical functions, and wellbeing of old people. "
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    ABSTRACT: Aim: Our aim was to detect older patients who were prescribed inappropriate drugs according to START/STOPP criteria in primary care. Materials and method: Patients aged over 65, admitted to health center no. 5 in Afyon, were included. The files of the subjects were surveyed retrospectively for the final one year in the digital environment, using the Family Medicine Information System. The files surveyed allowed us to list the drugs they used in the past year and to detect inappropriate drug use. Results: The number of patients that took part in this study was 325 (average age: 73.23 ± 6.44 years). We found that, among these participants, 48 patients (14.8%) were using drugs inappropriately according to STOPP criteria. Conclusion: Further focus on avoiding inappropriate drug use will allow clinicians and other health professionals to reduce side effects and other complications. In patients aged over 65, there is a need to attach particular importance to inappropriate drug use, drug interactions, and avoidance of side effects.
    Full-text · Article · Jun 2013 · The Scientific World Journal
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    Full-text · Article · Sep 2011 · The Annals of Family Medicine
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