Puk4 Cumulative Exposure to Nonsteroidal Anti-Inflammatory Drugs (Nsaids) and the Progression of Chronic Kidney Disease (Ckd)

Abstract

surement with more than one endpoint is the generation of a cardinal index/score. Without the prioritization and weighting of multiple endpoints a deduction of recommendations might be questionable. METHODS: A pilot study was conducted to elicit patients' preferences about antiviral therapy of chronic hepatitis C. For the Discrete-Choice-Experiment (DCE), 7 attributes were selected with 3 Levels each. Therefore an orthogonal, balanced and efficient design was used and results were analysed with random effects logit models. RESULTS: Patients and experts prioritized the respective endpoints in almost the same order, but weighted them differently. Sustained-Virological-Response received the highest weight followed by frequency of application (patients) or duration of therapy (experts). CONCLUSIONS: Aim was to demonstrate how DCEs can be used to empirically determine which PREs should be included in the efficiency frontier analysis. Further it is demonstrated how such methods can be used to prioritize across such multiple efficiency frontiers. The survey demonstrated how DCEs could be used to empirically determine which PREs are important in antiviral treatment of chronic hepatitis C. The results could be used for the development of innovative therapeutic schemes and new drugs which could meet patients' needs. For IQWiG purposes the weights of PREs are included in the health economic evaluation. OBJECTIVES:To determine health care provider perceptions about timing of 'rapid' warfarin reversal-related patient care events using novel survey methodology. METHODS: Forty-eight adult and pediatric trauma centers were contacted to participate in a direct-to-provider (DTP) survey. Participants were asked to provide aggregate information about patients receiving fresh-frozen plasma (FFP) for acute warfarin reversal. RESULTS: Nineteen to 25 health care professionals from 18 centers provided information by survey. Average perceptions of time needed to infuse FFP under this setting (mean 4.6 hrs from time of triage; 95% CI 1.0 -8.2 hrs) are consistent with actual, published values. In contrast, average perceptions of time needed for initial International Normalized Ratio (INR) normalization using FFP (mean 5.8 hrs; 95% CI 2.8 -8.8 hrs) underestimate actual, published values by 6 -26 hrs. Health care providers perceived that relatively little cumulative time lapses (1.6 hrs, on the average) for completing the first FFP infusion. There is little perceived time lag between ordering and beginning the first FFP infusion (0.3 hrs, on the average), consistent with actual, published values. There is substantial reported time (an additional 3.0 hrs, on the average) needed to complete subsequent FFP infusions, amounting to 52% of all perceived time lapsing for initial INR normalization in this setting. CONCLUSIONS: DTP survey methodology appears to be an efficient method for gathering clinical information for research purposes. Healthcare providers may have perceptions that are different from published studies, including inaccurate percep...

Analgesia dose prescribing and estimated glomerular filtration rate decline: a general practice database linkage cohort study

“…Normal or high dose NSAID prescribing in our study was not significantly associated with eGFR decline within a 2-year time-period. The findings are consistent with large published studies by Yarger et al , 20 Gooch et al , 16 Hemmelgarn et al , 23 Curhan et al , 8 Kurth et al , 19 and Rexrode et al , 21 who found no association between normal dose NSAID use (prescribed or OTC) and renal decline. Equally, a recent systematic review by Nderitu et al , 4 found no significant association between normal dose NSAID use and eGFR decline.…”

Selective cyclooxygenase-2 inhibitor use and progression of renal function in patients with chronic kidney disease: a single-center retrospective cohort study

“…The previous study showed that conventional NSAIDs increased the risk of renal progression and end-stage renal disease in CKD. The large cohort studies from Gooch et al, 6 Hemmelgarn et al, 11 and Yarger et al 12 demonstrated that accelerated CKD progression occurred in 10.9%-13.3% of the study participants. Although high cumulative NSAID exposure was significantly associated with an increased risk of accelerated CKD progression, regular NSAID use was not associated with an increased risk of accelerated CKD progression, especially among Stage 3 CKD patients.…”

Nonadherence of Oral Antihyperglycemic Medication Will Increase Risk of End-Stage Renal Disease

“…Previous studies have shown that regular NSAIDs use does not increase the risk of accelerated CKD progression. 34 – 36 Nderitu et al 34 proposed that high doses of NSAIDs use results in the increase of the risk which accelerates renal function decline. A possible explanation is that our data were assessed at the baseline and not throughout the study period.…”