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Kidney Week

Abstract: PO0423

NSAID Use Is Not Associated with Kidney Injury or Dysfunction in Ambulatory Older Adults

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Amatruda, Jonathan G., University of California San Francisco, San Francisco, California, United States
  • Sarathy, Harini, University of California San Francisco, San Francisco, California, United States
  • Peralta, Carmen A., University of California San Francisco, San Francisco, California, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
  • Fried, Linda F., VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Newman, Anne B., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
Background

NSAIDs cause AKI and may worsen CKD, especially in vulnerable populations such as older adults. We hypothesized that NSAID use would be associated with markers of both tubular and glomerular damage in older adults.

Methods

In the multicenter Health ABC cohort of ambulatory older adults, prescription and OTC NSAID use was self-reported. Estimated GFR by cystatin C, and urine albumin (ACR), KIM-1, and IL-18 were measured in 2,999 participants; urine a1m, NGAL, PIIINP, and UMOD were measured in a random subset of 500 participants. We evaluated cross-sectional associations between NSAID use and these biomarkers with separate linear regression models. The association between time-updated NSAID use and eGFR decline over 10 years was estimated with linear mixed models.

Results

Participants had a mean age of 74 years, 51% were female, and 41% African-American. No eGFR differences were detected between NSAID users (n=655) and non-users (n=2344) at baseline (72 mL/min/1.73m2 in both groups). Compared to non-users, NSAID users had 33% (95% CI: 11%-49%) lower adjusted odds of having ACR >30 mg/g and 11% (95% CI: 4%-18%) lower mean urine IL-18 concentration at baseline. No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non-users did not differ significantly in the rate of eGFR decline (-2.2% vs. -2.3% per year).

Conclusion

Among ambulatory older adults, NSAID use was not associated with kidney dysfunction or injury based upon eight measures of kidney health, and NSAIDs were associated with significantly lower urine albumin and IL-18 concentrations. These findings illustrate the potential for NSAID use without kidney harm, even in a presumably high-risk population.