Abstract: SA-PO896
Extended and High-Dose Nonsteroidal Anti-Inflammatory Drug Use Is a Risk Factor for CKD Incidence
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Jalal, Kabir, University at Buffalo, Amherst, New York, United States
- Venuto, Rocco C., Erie County Medical Center, Buffalo, New York, United States
- Charest, Andre F., UBMD Internal Medicine, Getzville, New York, United States
Background
The use of non-steroidal anti-inflammatory drugs (NSAIDS) and its risk for CKD progression is well known. However, risks for onset of CKD have not been definitively established. This study examined the extended use of NSAIDS and the extended use of high-dose NSAIDS among patients from a third-party insurer for risk of CKD development.
Methods
Serial observations from 2007 through 2017 were examined. Patients with valid serum creatinine measurements and complete supporting data, including other lab values (albumin, bilirubuin, calcium, sodium, potassium, hemoglobin, glucose, chloride, and carbon dioxide), medication use (NSAIDS, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, proton pump inhibitors, hydralazine, and antihistamines), and comorbid conditions (diabetes, hypertension, cardiovascular diseases, congestive heart failure, proteinuria) were included for analysis. In addition to chi-squared tests of association between NSAIDS use and CKD development, Kaplan-Meier survival analysis of time to CKD onset was stratified by NSAIDS use and log-rank tests were performed on the full sample and 1:1 matched samples of patients with 1) NSAIDS use in over 50% (NSAIDS-50) of their prescription history matched to similar controls; and 2) evidence of high-dose oral NSAIDs usage (NSAIDS-H) matched to similar NSAIDS-50 controls.
Results
80,619 patients qualified for the full data analysis, with 4,185 patients developing CKD, and 4,086 NSAIDS-50 patients (chi-sq p-value < 0.0001). In the NSAIDS-50 matched analysis, 514 of 8,172 patients develped CKD, 282 of which were NSAIDS-50 patients (chi-sq p-value = 0.0255). 755 patients were identified as NSAIDS-H patients with 54 developing CKD, while 34 of 755 controls developed CKD (chi-sq p-value = 0.0363). The full sample showed differences in log-rank tests of survival curves between NSAIDS and non-NSAIDS groups (p < 0.0001), as in the matched NSAIDS-50/non-NSAIDS-50 sample (p = 0.0033) and the matched NSAIDS-H/non-NSAIDS-H sample (p = 0.0167).
Conclusion
While establishing firm dosing and exposure guidelines requires further research, this study suggests that extended and/or high-dose usage of NSAIDS carries an increased risk of CKD onset. Additional multivariate analysis to confirm the reliability and extent of these findings is underway and will be presented.
Funding
- Other U.S. Government Support