Kidney Week

Abstract: SA-PO908

Association of Pharmacotherapy for Nausea and Vomiting Symptoms With Incident CKD and the Role of Confounding by Indication

Session Information

• CKD: Clinical Trials and Pharmacoepidemiology
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

• Kalantar, Diana S., University of California Irvine Medical Center, Orange, California, United States

Diana S. Kalantar,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida,

• Lu, Jun Ling, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Jun Ling Lu,

• Kalantar-Zadeh, Kamyar, University of California Irvine Medical Center, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Streja, Elani, University of California Irvine Medical Center, Orange, California, United States

Elani Streja,

Background

Nausea and vomiting are effectively treated with pharmacotherapy. Potential associations of anti-emetic therapy with adverse kidney outcomes may reflect confounding by indication (CBI). We aimed to examine the association of anti-emetic therapies with the incidence of new onset CKD across Propensity Score (PS) methods that account for CBI.

Methods

In a historical cohort of 323,970 US Veterans with normal baseline eGFR (≥60 ml/min/1.73m²) during 2004-2006, we identified 13,154 Veterans who were incident new anti-emetic therapy users. We used clinical trial emulation methods to model the associations of anti-emetic use with incident CKD (defined as eGFR <60 ml/min1.73m² on two separate occasions with at least 90 days in-between) including PS matching and PS weighing.

Results

Non-users and users of anti-emetics were 64.1±14.2 and 62.1±12.9 (mean±SD) years old, respectively and anti-emetic users were more likely to be female, smokers, and had higher frequencies of comorbidities. Anti-emetic use (vs. non-use) was associated with a higher risk of incident CKD in unadjusted analyses (hazard ratio and 95%CI: 1.26, 1.22-1.31), and in PS matched (1.22, 1.17-1.28) and PS weighed analyses (1.28, 1.18-1.46) respectively [figure].

Conclusion

Anti-emetic medication use was associated with 22% to 28% higher risk of incident CKD in patients with no preexisting kidney disease. This association appears robust across different PS implementation models suggesting less likely involvement of confounding by indication as the explanation. The potential causality of this association still needs to be tested in additional studies, including clinical trials.

Kaplan-Meier Curves of Propensity Score Matched and Weighted Models

Funding

• NIDDK Support