Iron Status and the Use of Non‐Steroidal Anti‐Inflammatory Drugs in Hemodialysis Patients

Abstract

We examined whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) can affect the anemia and iron status of hemodialysis patients. We recruited patients from six dialysis centers who had undergone maintenance hemodialysis for at least four months. We examined the use of NSAIDs during the past three months based on their medical records and assigned the patients to three groups (group A, non-NSAID group; group B, aspirin group; and group C, non-aspirin NSAID group). Of the 446 patients, 95 (21.3%) were treated with aspirin and 103 (23.1%) were treated with non-aspirin NSAIDs. The serum iron level and transferrin saturation (TSAT) were significantly lower in group C patients than those in group A. However, the ratio of the patients who were administrated iron preparations during the past three months was significantly higher than that in the other two groups. The incidences of positive fecal occult blood tests did not differ substantially between the three groups. The ratios of the patients who were administrated recombinant human erythropoietin were the same between three groups. Using a multiple regression analysis, the administration of non-aspirin NSAIDs was identified as an independent factor for the decreased serum iron and the decreased TSAT levels. A multiple logistic regression analysis revealed that the patients using non-aspirin NSAIDs had an increased the requirement for iron preparation therapy (OR 2.03, 95% CI, 1.28-3.22). The use of non-aspirin NSAIDs may therefore increase the risk of the iron deficiency in patients undergoing hemodialysis.

Cross-sectional small intestinal surveillance of maintenance hemodialysis patients using video capsule endoscopy: SCHEMA study

“…As mentioned above, small intestinal abnormalities in HD patients might be caused by multiple factors such as uremia, NSAID and/or low-dose aspirin use, and microcirculatory disorders. Other studies have found that uremia can cause gastrointestinal mucosal abnormalities 3 29 ; non-aspirin NSAID users had a higher incidence (71 %) of small intestinal mucosal injury 28 ; non-aspirin NSAID use decreased the serum iron level of HD patients 30 ; and low-dose aspirin can cause small intestinal mucosal injury 31 32 33 . The small bowel abnormalities might be a reflection of multiple complicating disorders, demonstrating their impact on prognosis.…”

The Link between Iron Turnover and Pharmacotherapy in Transplant Patients

“…Another hypertensive drug, amlodipine, was reported to decrease iron overload and to reduce ferritin levels in patients with thalassemia major [ 47 ]. Nonsteroidal anti-inflammatory drugs (NSAIDs) (loxoprofen, diclofenac, ampiroxicam, naproxen, etodolac) are supposed to increase the risk of iron deficiency in chronic hemodialysis patients, according to Wang et al [ 52 ]. However, acetylsalicylic acid in a representative cohort did not affect serum iron or iron saturation [ 48 ].…”

Pharmacological Treatment may Impair Mineral Status in Blood

“…Nonsteroidal anti-inflammatory drugs, when taken regularly, may cause bleeding from the gastrointestinal tract and iron loss with the blood. The use of aspirin and other medicines belonging to this group of drugs may therefore increase the risk of iron deficiency, which can be identified as a low hemoglobin and serum ferritin concentration [4,7].…”