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Kidney Week

Abstract: TH-PO061

NSAID Use and NSAID-Associated AKI Before and After Implementation of Pennsylvania’s Prescription Drug Monitoring Program

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Ray, Evan C., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Bilderback, Andrew, UPMC, Pittsburgh, Pennsylvania, United States
  • Schwenk, Amanda, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Dealmeida, Dilhari, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background

Few studies describe the influence of prescription drug monitoring programs (PDMPs) on NSAID use or NSAID-associated adverse effects. We asked whether implementation of Pennsylvania’s PDMP, designed to reduce narcotic use, was associated with changes in inpatient NSAID administration or NSAID-related Acute Kidney Injury (AKI) in western Pennsylvania (UPMC) hospitals.

Methods

We examined retrospective data from 16 UPMC hospitals in three PA PDMP phases: pre-PDMP (Jan 1-Aug 25, 2016), voluntary PDMP participation (Aug 26-Dec 31, 2016), and mandatory PDMP participation (Jan 1-Dec 31, 2017). Patients with ICD-10 codes indicating ESRD or kidney transplant were excluded. Outcomes included percent of admissions with any NSAID use and with prolonged NSAID use (≥ 4 days) and frequency of NSAID-associated AKI. AKI was defined by presence of both a creatinine-based electronic flag and an ICD-10 code for atraumatic, non-obstructive AKI. Outcomes were compared during each phase using chi-square tests, and interrupted time-series analyses were used to examine the impact of each phase over time.

Results

Inpatient visits in the pre-, voluntary, and mandatory PDMP phases totaled 95,550; 52,344; and 151,251, respectively. Across the three phases, hospitalizations with any NSAID use increased (77.1% pre- vs 78.3% voluntary vs 79.5% mandatory PDMP, p<0.001). Additionally, hospitalizations with prolonged NSAID use increased across the three phases (32.1% pre- vs 32.6% voluntary vs 33.9% mandatory PDMP, p=0.001). In interrupted time series analysis, receipt of any NSAIDs increased 1.4% with implementation of the voluntary phase (p <0.001), and AKI incidence increased 0.7% with implementation of the mandatory phase (p=0.06). Across all phases, patients with CKD were particularly susceptible to NSAID-associated AKI with prolonged NSAID use, as 42.0% of CKD patients receiving NSAIDs for ≥ 4 days experienced AKI, compared to 29.9% of CKD patients receiving < 4 days of NSAIDs (p = 0.001).

Conclusion

We find that implementation of the PA PDMP was associated with a significant increase in NSAID use and duration in inpatient UPMC facilities and a marginally significant and temporally correlated increase in AKI. Further analyses will examine whether AKI increased more dramatically in specific high-risk patient subsets.

Funding

  • NIDDK Support