Patterns of NSAIDs Use and Their Association with Other Analgesic Use in CKD

Zhan, Min; Peter, Wendy L. St.; Doerfler, Rebecca M.; Woods, Corinne; Blumenthal, Jacob B.; Diamantidis, Clarissa J.; Hsu, Chi-yuan; Lash, James P.; Lustigova, Eva; Mahone, Erin B.; Ojo, Akinlolu; Slaven, Anne; Strauss, Louise; Taliercio, Jonathan J.; Winkelmayer, Wolfgang C.; Xie, Dawei; Fink, Jeffery C.

doi:10.2215/cjn.12311216

Cited by 29 publications

(22 citation statements)

References 30 publications

(28 reference statements)

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“…Three prevalence groupings were extracted that had sufficient data to complete full meta-analyses: overall analgesic use prevalence (17 studies), 14,[16][17][18]20,23,25,29,33,36,37,43,45,46,48,49,52 opioid use prevalence (13 studies), [14][15][16]18,19,21,24,26,31,37,38,40,44 and NSAID use prevalence (19 studies). 14,15,19,20,22,[26][27][28]30,32,34,35,37,[39][40][41][42]47,50 A meta-analysis was also done for acetaminophen use, which included 8 studies, 14,…”

Section: Details Of Included Studiesmentioning

confidence: 99%

Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Rathwell

George

Hussain

et al. 2020

Can J Kidney Health Dis

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Background: Pain is common in patients with chronic kidney disease (CKD). Analgesics may be appropriate for some CKD patients. Objectives: To determine the prevalence of overall analgesic use and the use of different types of analgesics including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvants, and opioids in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with stage 3-5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of analgesic use, and the types of analgesics prescribed. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of analgesic use and the I2 statistic was computed to measure heterogeneity. Random-effects models were used to account for variations in study design and sample populations, and a double arcsine transformation of the prevalence variables was used to accommodate potential overweighting of studies with very large or very small prevalence measurements. Sensitivity analyses were performed to determine the magnitude of publication bias and assess possible sources of heterogeneity. Results: Forty studies were included in the analysis. The prevalence of overall analgesic use in the random-effects model was 50.8%. The prevalence of acetaminophen, NSAIDs, and adjuvant use was 27.5%, 17.2%, and 23.4%, respectively, while the prevalence of opioid use was 23.8%. Due to the possibility of publication bias, the actual prevalence of acetaminophen use in patients with advanced CKD may be substantially lower than this meta-analysis indicates. A trim-and-fill analysis decreased the pooled prevalence estimate of acetaminophen use to 5.4%. The prevalence rate for opioid use was highly influenced by 2 large US studies. When these were removed, the estimated prevalence decreased to 17.3%. Limitations: There was a lack of detailed information regarding the analgesic regimen (such as specific analgesics used within each class and inconsistent accounting for patients on multiple drugs and the use of over-the-counter analgesics such as acetaminophen and NSAIDs), patient characteristics, type of pain being treated, and the outcomes of treatment. Data on adjuvant use were very limited. These results, therefore, must be interpreted with caution. Conclusions: There was tremendous variability in the prescribing patterns of both nonopioid and opioid analgesics within and between countries suggesting widespread uncertainty about the optimal pharmacological approach to treating pain. Further research that incorporates robust reporting of analgesic regimens and links prescribing patterns to clinical outcomes is needed to guide optimal clinical practice.

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Section: Details Of Included Studiesmentioning

confidence: 99%

Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Rathwell

George

Hussain

et al. 2020

Can J Kidney Health Dis

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“…One recent study suggested that starting and stopping NSAIDs were both associated with higher odds of increased alternative analgesic use, including opioids, in patients with chronic kidney disease. 21 Moreover, inclusion of NSAIDs and celecoxib in the postoperative setting following ambulatory surgery has been found to decrease the need for rescue analgesics and improve quality of recovery and patient satisfaction. 22 Notably, no studies have previously examined the impact of nonantibiotic drug ADR reporting on drug utilization patterns and outcomes such as OUD, which have important implications for patient care and safety.…”

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confidence: 99%

Impact of reported NSAID “allergies” on opioid use disorder in back pain

Chang

Song

et al. 2021

Journal of Allergy and Clinical Immunology

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Background: It is crucial to identify patients at highest risk for opioid use disorder (OUD) and to address challenges in reducing opioid use. Reported nonsteroidal anti-inflammatory drug (NSAID) allergies may predispose to use of stronger pain medications and potentially to OUD. Objective: We sought to investigate the clinical impact of reported NSAID allergy on OUD in patients with chronic back pain. Methods: We conducted a retrospective study of adults receiving care at a tertiary health care system from January 1, 2013, to December 31, 2018. Back pain and OUD were identified using administrative data algorithms. We used propensity score matching and logistic regression to estimate the impact of selfreported NSAID adverse drug reactions (ADRs) on risk of OUD, adjusting for other relevant clinical information. Results: Of 47,114 patients with chronic back pain, 3,620 (7.7%) had a reported NSAID ADR. In an adjusted propensity scorematched analysis, patients with NSAID ADRs had higher odds (odds ratio, 1.34; 95% CI, 1.07-1.67) of developing OUD as compared with those without NSAID ADRs. Additional risk factors for OUD included younger age, male sex, Medicaid insurance, Medicare insurance, higher number of inpatient and outpatient visits in the previous year, and comorbid anxiety and

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“…Patients exposed to prescription and OTC NSAIDs in our cohort had a higher burden of risk factors for kidney injury as well as other side effects of this drug class. 8 A subanalysis of the Chronic Renal Insufficiency Cohort found that 24% of participants reported use of NSAIDs suggesting that despite evidence for risk, clinicians still prescribe NSAIDs. 9 Knowledge about NSAIDs and kidney risks in the general population is poor, especially with regard to OTC products.…”

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confidence: 99%