Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study

ElHafeez, Samar Abd; Hegazy, Reem; Naga, Yasmine; Wahdan, Iman; Sallam, Sunny

doi:10.1186/s42506-018-0005-2

Cited by 19 publications

(21 citation statements)

References 27 publications

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“…Specifically, acetylsalicylic acid was used in these patients as a platelet aggregation inhibitor. A higher use of acetylsalicylic acid in patients with CKD was observed in other studies (Ingrasciotta et al, 2014;Abd ElHafeez et al, 2019;Okoro and Farate, 2019;Barbieri et al, 2020). Patients mostly treated with low-dose acetylsalicylic acid were those with a registered diagnosis of CKD.…”

Section: Discussionsupporting

confidence: 57%

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

et al. 2021

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Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010–2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16–1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38–25.12, p < 0.001; G5: 19.38, 11.51–32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.

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Section: Discussionsupporting

confidence: 57%

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

et al. 2021

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“…Furthermore, acetylsalicylic acid was the most inappropriately prescribed medication of all contraindicated prescriptions followed by diclofenac, etoricoxib, and metformin. A higher use of acetylsalicylic acid, diclofenac, and coxib in patients with CKD was observed in other studies [20,23,37]. It is well known that different drugs, including NSAIDs, have a crucial role in the occurrence of nephrotoxic effects induced by the decrease in GFR values and vasodilatation.…”

Section: Discussionmentioning

confidence: 70%

Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

Rottura

Cicala

Mandraffino³

et al. 2020

JCM

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Nephrotoxic drugs prescriptions are often prescribed inappropriately by general practitioners (GPs), increasing the risk of chronic kidney disease (CKD). The aim of this study was to detect inappropriate prescriptions in patients with CKD and to identify their predictive factors. A retrospective study on patients with creatinine values recorded in the period 2014–2016 followed by 10 GPs was performed. The estimated glomerular filtration rate (eGFR) was used to identify CKD patients. The demographic and clinical characteristics and drugs prescriptions were collected. A descriptive analysis was conducted to compare the characteristics and logistic regression models to estimate the predictive factors of inappropriate prescriptions. Of 4098 patients with creatinine values recorded, 21.9% had an eGFR <60 mL/min/1.73 m2. Further, 56.8% received inappropriate prescriptions, with a significantly lower probability in subjects with at least a nephrologist visit (Adj OR 0.54 (95% CI 0.36–0.81)) and a greater probability in patients treated with more active substances (1.10 (1.08–1.12)), affected by more comorbidities (1.14 (1.06–1.230)), or with serious CKD (G4/G5 21.28 (7.36–61.57)). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most used contraindicated drugs (48.5%), while acetylsalicylic acid was the most inappropriately prescribed (39.5%). Our results highlight the inappropriate prescriptions for CKD authorized by GPs and underline the need of strategies to improve prescribing patterns.

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“…62,85 Risk factors include older age, renal impairment, heart failure, liver disease, diabetes mellitus (DM), and concurrent prescription with antihypertensive drugs (eg, diuretics, renin-angiotensin system inhibitors). 62,86,87 Again, mechanisms of NSAID-induced kidney damage relate to inhibition of prostaglandin synthesis and are dose-and duration-dependent. 80,81 Low levels of COX-2 are constitutively expressed in the macula densa, with COX-2 inhibition leading to a reduction in renal blood flow and resulting functional impairment.…”

Section: Renal Risksmentioning

confidence: 99%

<p>Practice Advisory on the Appropriate Use of NSAIDs in Primary Care</p>

Ho¹,

Cardosa²,

Chaiamnuay³

et al. 2020

JPR

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Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.

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Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study

Cited by 19 publications

References 27 publications

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

<p>Practice Advisory on the Appropriate Use of NSAIDs in Primary Care</p>

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