Characterising risk of non-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study

Abstract

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions.AimThis study aimed to measure the extent of NSAID prescribing in an adult population, the degree to which patients with potential higher risk of AKI were exposed to NSAIDs, and to quantify their risk of AKI.Design & settingRetrospective two-year closed-cohort study.MethodA retrospective cohort of adults was identified from a pseudonymised electronic primary care database in Hampshire, UK. The cohort had clinical information, prescribing data and complete GP- and hospital- ordered biochemistry data. NSAID exposure (minimum one prescription in a two-month period) was categorised as never, intermittent and continuous, and first AKI using the national AKI eAlert algorithm. Descriptive statistics and logistic regression were used to explore NSAID prescribing patterns and AKI risk.ResultsThe baseline population was 702,265. NSAID prescription fell from 19,364 (2.8%) to 16,251 (2.4%) over two years. NSAID prescribing was positively associated with older age, women, greater socioeconomic deprivation, and certain comorbidities (diabetes, hypertension, osteoarthritis and rheumatoid arthritis) and negatively with cardiovascular disease (CVD) and heart failure. Among those prescribed NSAIDs, AKI was associated with older age, greater deprivation, CKD, CVD, heart failure, diabetes, and hypertension.ConclusionsDespite generally good prescribing practice, we identified NSAID prescribing in some people at higher risk of AKI (CKD, older people) for whom medication review and NSAID de-prescribing should be considered.

Prescripción de antiinflamatorios y antirreumáticos no esteroideos en pacientes hipertensos ambulatorios

“…Un análisis realizado en pacientes con crisis hipertensiva reveló que 53.3 % de ellos tomaban AINE. 20 Por otro lado, a pesar de estar bien documentados los daños y las pautas de prescripción de los AINE, estos se prescriben a personas con alto riesgo de desarrollar insuficiencia renal aguda, 21 situación que se identificó en este estudio. La investigación hizo posible detectar errores de prescripción en esquemas combinados de antihipertensivos, ya que la combinación de IECA y ARA II ocasiona cambios en la función renal e, incluso, insuficiencia renal aguda; [22][23][24] 23.5 5.9 5.9…”

“…27 En la literatura se ha reportado que padecer hipertensión arterial constituye un factor asociado a la prescripción de AINE, y algunos autores han propuesto que estos pacientes cursan con una elevada carga de enfermedades musculoesqueléticas (como se identificó en la investigación que se presenta), cuyo tratamiento depende de los AINE. 21 El papel del médico familiar es fundamental para evitar la polimedicación y la IF-F, por lo que es importante que revise los fármacos prescritos por otros médicos, tome en cuenta la automedicación y realice una anamnesis farmacológica detallada. 28 Con este trabajo se obtuvo información relevante, pero tiene limitaciones dada su naturaleza transversal y el muestreo no probabilístico; sin embargo, la información refleja el comportamiento del problema en un ambiente habitual de la atención médica y puede servir de sustento para implementar acciones dirigidas a disminuir la prescripción inapropiada de AINE.…”

The histomorphology of the senescent kidney – the clinical relevance of specimen and biopsy findings in the elderly native kidneys

“…Acute kidney injury accounts for a large part of renal adverse events and is not necessarily an indication for kidney biopsy. Antibiotics and nonsteroidal antiinflammatory drugs are common nephrotoxic drugs in the ageing patient [23][24][25]. When leading to a diagnostic kidney biopsy, recently available drugs are now known for their potential renal adverse effects in older patients: immune checkpoint inhibitors can trigger interstitial nephritis, renal vasculitis or thrombotic microangiopathy [26][27][28]; traditional medicinal herbs can induce oxalate nephropathy [29] or aristolochic acid nephropathy.…”

Literature review: are NSAIDs harmful and is acetaminophen well tolerated?

“…In light of this, it is worth mentioning that even if risk factors for NSAID-induced AKI are well known, NSAID prescribing is still prevalent in these high-risk groups. As such, it is advisable for clinicians to review NSAID prescribing processes and implement guidelines to avoid NSAID prescriptions in high-risk groups [16].…”