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Kidney Week

Abstract: PO0028

Nonsteroidal Anti-Inflammatory Drugs and Risk of Acute Adverse Renal Outcomes in Diabetes

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Abdul Kadir, Hanis Binte, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Choo Chon Jun, Jason, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Ang, Teck Wee Andrew, SingHealth Polyclinics, Singapore, Singapore
  • Bee, Yong Mong, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Tan, Ngiap chuan, SingHealth Polyclinics, Singapore, Singapore
Background

Individuals with diabetes mellitus (DM) may be susceptible to non-steroidal anti-inflammatory drug (NSAID) –induced acute kidney injury (AKI). However, data on their risk of NSAID-related adverse renal events is sparse. We aimed to evaluate the risk and factors for acute kidney injury and/or hyperkalemia after NSAID prescription to individuals with DM.

Methods

Retrospective cohort study of individuals ≥21 years with DM who received prescriptions between 1st July 2015 and 30th December 2017 from the largest tertiary hospital and a major public primary care institution in Singapore.

Laboratory, hospitalization and medication data from 6 months before until 30 days after first prescription were retrieved from electronic medical records. Individuals prescribed systemic NSAID >14 days were identified as the “NSAID” group. We excluded those with systemic NSAID in the preceding 6 months, missing laboratory values, or had baseline estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2.

The outcome was the incidence of AKI (serum creatinine increased >50%) and/ or hyperkalemia (serum potassium >5.5 mmol/L) within 30 days after prescription.

Results

We studied 3896 individuals (mean age 64.5 ± 13.3 years) with incident prescriptions: 138 in the NSAID group and 3758 in the non-NSAID group.

30-day AKI and/or hyperkalemia occurred in 525 individuals (13.5%). After adjusting for age, gender, ethnicity, baseline CVD, eGFR, serum potassium, NSAID, RAAS blocker and diuretic, baseline CVD (adjusted OR 1.41, 95% CI 1.03-1.93, p=0.03), RAAS blocker (adjusted OR 1.42, 95% CI 1.15-1.75, p=0.001), diuretic (adjusted OR 1.91, 95% CI 1.53-2.38, p<0.001) and higher baseline serum potassium (adjusted OR 1.36, 95% CI 1.19-1.57, p<0.001) were independent predictors for the outcome.

NSAID prescription for >14 days was associated with a higher 30-day risk of AKI and/or hyperkalemia (adjusted OR 1.62, 95% CI 0.99 – 2.65, p=0.05). However, the risk of AKI and/or hyperkalemia was markedly increased if NSAID was prescribed concurrently with RAAS blocker (adjusted OR 4.17, 95% CI 1.74–9.98, p=0.001) or diuretic (adjusted OR 3.31, 95% CI 1.09-10.08, p=0.04).

Conclusion


NSAID prescription in individuals with DM may be associated with higher 30-day risk of AKI and/or hyperkalemia, especially with concurrent RAAS blocker or diuretic.

Funding

  • Private Foundation Support