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NSAIDs may be safe in chronic kidney disease

SAN DIEGO — The estimated glomerular filtration rate was not significantly affected by NSAID prescription or self-reported use among patients with chronic kidney disease, according to data presented at ASN Kidney Week 2018.

“We wanted to determine whether prescription or self-reported use of NSAIDs was associated with an increase in the progression of CKD,” Linda Awdishu, PharmD, MAS, health sciences associate clinical professor of pharmacy at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, told Healio Internal Medicine. “We felt that this would be of significance considering the opiate crisis that is going on in the United States. It is important for physicians to know about the safety of NSAIDs in CKD.”

Awdishu and colleagues conducted a retrospective analysis of 1,736 patients aged 18 years or older with CKD stage 3 to 5, defined as having an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m² on two separate occasions. Hospitalized patients, transplant recipients, patients with acute kidney injury episodes or those with dialysis dependency were excluded from the analysis.

The researchers measured the prevalence of NSAID prescription or patient-reported use and compared the mean change in eGFR of those who had a prescription or self-reported use to those who did not have prescription or self-reported use over a study period of 1 year.

Overall, 7% of participants were exposed to NSAIDs.

There were no statistically significant differences in gender, age and comorbidities, such as HIV, hypertension, chronic lung disease, diabetes, dementia and hepatitis C, between the two groups, according to Awdishu.

The mean decline in eGFR was 5.7 mL/min/1.73 m² for NSAID users and 4.4 mL/min/1.73 m² for nonusers, she said. This mean decline was not statistically significant, but was trending towards significance.

The researchers used a multilinear regression model to account for other covariates in CKD progression and found that NSAID prescription or self-reported use did not achieve statistical significance, according to Awdishu. Therefore, there was no apparent increased risk in CKD progression from NSAID use in a 1-year period of time, she said.

“There is emerging data to suggest that maybe the use of NSAIDs short-term under monitoring by the clinician might be safe, but further studies are needed to assess whether we can replicate these findings for the decline in GFR,” Awdishu said. – by Alaina Tedesco

Reference:

Chan SL, et al. Abstract: SA-PO622. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.