AJM online
Clinical research study
NSAID Use and Progression of Chronic Kidney Disease

https://doi.org/10.1016/j.amjmed.2006.02.015Get rights and content

Abstract

Purpose

The effects of nonselective and selective cyclooxygenase-2 specific (COX-2) nonsteroidal anti-inflammatory drug (NSAID) use on the progression of chronic kidney disease (CKD) is uncertain. Due to the high prevalence of both CKD and NSAID use in older adults, we sought to determine the association between NSAID use and the progression of CKD in an elderly community-based cohort.

Methods

All subjects ≥66 years of age who had at least one serum creatinine measurement in 2 time periods (July-December, 2001 and July-December, 2003) were included. Multiple logistic regression analyses, including covariates for age, sex, baseline estimated glomerular filtration rate (eGFR), diabetes, and comorbidity were used to explore the associations of NSAID use on the primary (decrease in eGFR of ≥15 mL/min/1.732) and secondary (mean change in eGFR) outcomes.

Results

A total of 10,184 subjects (mean age 76 years; 57% female) were followed for a median of 2.75 years. High-dose NSAID users (upper decile of cumulative NSAID exposure) experienced a 26% increased risk for the primary outcome (odds ratio [OR] 1.26, 95% confidence interval [CI], 1.04-1.53). A linear association between cumulative NSAID dose and change in mean GFR also was seen. No risk differential was identified between selective and nonselective NSAID users.

Conclusions

High cumulative NSAID exposure is associated with an increased risk for rapid CKD progression in the setting of a community-based elderly population. For older adult patients with CKD, these results suggest that nonselective NSAIDs and selective COX-2 inhibitors should be used cautiously and chronic exposure to any NSAID should be avoided.

Section snippets

Study Population

The Conjoint Ethics Review Board at the University of Calgary approved this study. A cohort of elderly subjects aged ≥66 years were identified from the Calgary Laboratory Services database in Calgary, Alberta, Canada. This laboratory provides testing for the entire Calgary Health Region (catchment population 1.1 million) using a single regional laboratory and standardized methods that are recalibrated routinely against reference samples. To be eligible for inclusion in this study, participants

Results

There were 12,641 subjects ≥66 years of age identified who had at least 1 outpatient measurement of serum creatinine in each of the 2 defined time periods. As outlined in Figure 1, a total of 2545 patients were excluded as they did not meet the inclusion criterion, for a final study cohort of 10,184.

Baseline subject characteristics by type of NSAID are shown in Table 1. Baseline subject characteristics varied by type of NSAID, with traditional NSAID users tending to be younger, male, and have a

Discussion

In this prospective community-based study of over 10,000 elderly subjects a small, but statistically significant, increased risk of rapid progression of chronic kidney disease was found only among subjects with a baseline mean glomerular filtration rate between 60 and 89 mL/min/1.73 m2 who were exposed to nonselective NSAIDs only or to COX-2 inhibitors only. NSAID use was not associated with an increased risk of rapid progression of chronic kidney disease for subjects with lower levels of

References (24)

  • C.M. Clase et al.

    Prevalence of low glomerular filtration rate in nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III)

    J Am Soc Nephrol

    (2002)
  • B.F. Culleton et al.

    Prevalence and correlates of elevated serum creatinine levels: the Framingham Heart Study

    Arch Intern Med

    (1999)
  • Cited by (245)

    View all citing articles on Scopus

    Supported by The Kidney Foundation of Canada and Alberta Improvements for Musculoskeletal Disorders Study.

    View full text