Nonselective and Cyclooxygenase-2-Selective NSAIDs and Acute Kidney Injury - 20/08/11
, Sushrut S. Waikar, MD, MPH b, Helen Mogun, MS a, Daniel H. Solomon, MD, MPH a, c
Requests for reprints should be addressed to Wolfgang C. Winkelmayer, MD, ScD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120Abstract |
Objective |
The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and acute kidney injury is well established, but it is less clear whether this risk is focused with specific agents. We undertook a large pharmacoepidemiologic analysis of the risk of acute kidney injury among older adults using nonselective NSAIDs or cyclooxygenase (COX)-2 inhibitors.
Methods |
Medicare beneficiaries from 2 large states with drug benefit were eligible for study. Patients were included if they filled a prescription for a nonselective NSAID or COX-2 inhibitor after more than 6 months without any such prescriptions and without a previous diagnosis of acute kidney injury. Incident acute kidney injury was ascertained from hospitalization claims within 45 days of initiating nonselective NSAID or COX-2 inhibitor therapy. Adjusted proportional hazards models estimated the relative risk of acute kidney injury associated with each agent compared with celecoxib.
Results |
We included 183,446 patients whose mean age was 78 years; 80% were women. Acute kidney injury was identified in 870 (0.47%) of nonselective NSAID or COX-2 inhibitor users. The agents with significantly elevated risk compared with celecoxib were indomethacin (rate ratio [RR] = 2.23; 95% confidence interval [CI], 1.70-2.93), ibuprofen (RR = 1.73; 95% CI, 1.36-2.19), and rofecoxib (RR = 1.52; 95% CI, 1.26-1.83). These findings were robust in several subgroups.
Conclusion |
Acute kidney injury requiring hospitalization is a relatively rare adverse event among older adults after initiation of nonselective NSAIDs or COX-2 inhibitor treatment, observed in approximately 1 in 200 new users within 45 days. There seems to be a marked gradient of risk for acute kidney injury across agents, specifically for indomethacin, ibuprofen, and rofecoxib.
Le texte complet de cet article est disponible en PDF.Keywords : Acute renal failure, Adverse event, NSAID, Pharmacoepidemiology
Plan
| Funding: No external funding. |
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| Conflict of interest: Dr Winkelmayer is supported by a Scientist Development Grant from the American Heart Association (0535232N), a Norman S. Coplon Extramural Research Program Award from Satellite Healthcare, Inc, and investigator-initiated grants from Amgen, Fresenius Medical Care, and GlaxoSmithKline. He has participated, without receiving an honorarium, in advisory boards of Amgen, Roche, Genzyme, and Fresenius. He has no personal financial relationships with any pharmaceutical company. Dr Solomon has served as the Principal Investigator on research grants in the past 5 years from Merck, Pfizer, and Savient. None of these are currently active. He has received salary support from a research grant from GSK in the past 3 years. This is not currently active. He serves as an unpaid member of the Executive Committee for a Pfizer sponsored clinical trial regarding NSAIDs. He also has served as an unpaid member of Advisory Boards for Amgen and Abbott. He has no personal financial relationships with any pharmaceutical company. Dr Waikar and Helen Mogun have no potential conflicts of interest to report. |
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| Authorship: All authors had access to the data. Drs Winkelmayer and Solomon collaborated closely on designing the study, developing the analytic protocols, interpreting the statistical output, and writing the article. Dr Waikar helped interpret the results and reviewed and refined the article draft, and Helen Mogun conducted the statistical analyses. |
Vol 121 - N° 12
P. 1092-1098 - décembre 2008 Retour au numéro
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