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Kidney Week

Abstract: TH-PO063

Risk of AKI and Hyperkalemia Among Older Patients Prescribed Non-Steroidal Anti-Inflammatory Drugs

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Nash, Danielle Marie, McMaster University, Hamilton, Ontario, Canada
  • Garg, Amit X., Western University, London, Ontario, Canada
Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and inflammation. Clinical guidelines caution against NSAID use in older patients due to high risk of acute kidney injury, but better evidence is needed to inform clinical care for those most at risk. The objective of this study was to determine the risk of acute kidney injury and hyperkalemia associated with long-term prescription NSAID use among older patients, and risk factors associated with these outcomes.

Methods

We conducted a population-based retrospective cohort study using linked healthcare data from Ontario, Canada. We identified patients >66 years with a new NSAID prescription with a day supply >14 days between 2007 and 2015. We propensity-score matched NSAID users to non-users and performed conditional logistic regression on 30-day risk of acute kidney injury, hyperkalemia, all-cause mortality, and hospital encounter with ventricular arrhythmia. We also developed a logistic regression model of predictors for acute kidney injury or hyperkalemia among NSAID users.

Results

We identified 61,219 eligible NSAID users and 156,589 eligible non-users. We matched 46,107 NSAID users to 46,107 non-users (mean age 74 years, 58% female). NSAID users were significantly more likely to develop acute kidney injury and hyperkalemia compared to non-users (see Table). Our prediction model included six baseline factors that were significantly associated with acute kidney injury or hyperkalemia (C-statistic adjusted for Harrell’s optimism: 0.72, 95% CI: 0.70-0.74): older age, male gender, lower baseline estimated glomerular filtration rate, higher baseline serum potassium, angiotensin converting enzyme inhibitor or angiotensin receptor blocker prescription, and diuretic prescription. This model will be available as an online calculator through the QxMD Calculate application.

Conclusion

Older patients prescribed NSAIDs for more than 14 days are at greater risk for acute kidney injury and hyperkalemia compared to non-users. We have developed an online calculator to help inform clinical decision making for NSAID prescribing in this population.

OutcomeNSAID users, n (%)Non-users, n (%)Odds ratio (95% CI)Risk difference (95% CI)Number needed to harm (95% CI)
Acute kidney injury380 (0.82)272 (0.59)1.41 (1.20-1.65)0.23 (0.13-0.34)427 (292-787)
Hyperkalemia184 (0.40)123 (0.27)1.50 (1.20-1.89)0.13 (0.06-0.20)756 (485-1715)
All-cause mortality66 (0.14)79 (0.17)0.83 (0.60-1.16)-0.03 (-0.08-0.02)N/A
Hospital encounter with ventricular arrhythmia71 (0.15)76 (0.16)0.93 (0.67-1.29)-0.0001 (-0.06-0.70)N/A

Funding

  • Government Support - Non-U.S.