Short-Term Non-Steroid Anti-Inflammatory Drug Use in Spondyloarthritis Patients Induces Subclinical Acute Kidney Injury: Biomarkers Study

Shukla, Anuj; Kumar, Mandhir; Prasad, Narayan; Agarwal, Vikas

doi:10.1159/000455167

Cited by 20 publications

(32 citation statements)

References 39 publications

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“…15, 16 In a recent study, chronic NSAID exposure in adults with spondyloarthritis was associated with a significant rise in urinary NGAL. 17 To our knowledge, our study is the first to demonstrate subclinical kidney injury associated with the use of a nephrotoxic medication in hospitalized children.…”

Section: Discussionmentioning

confidence: 68%

Subclinical Kidney Injury in Children Receiving Nonsteroidal Anti-Inflammatory Drugs After Cardiac Surgery

Nehus

Kaddourah

Bennett

et al. 2017

The Journal of Pediatrics

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Objective To investigate the association of nonsteroidal anti-inflammatory drug (NSAID) administration with urinary neutrophil gelatinase-associated lipocalin (NGAL) levels in children following cardiopulmonary bypass (CPB) who did not develop acute kidney injury (AKI). Study design In this prospective observational study, urinary NGAL levels were investigated in 210 children who underwent cardiothoracic surgery requiring CPB. Children with clinical AKI (increase in serum creatinine ≥50% from baseline within 72 hours of CPB) were excluded from analysis. NSAIDs were administered no sooner than 24 hours after CPB. NGAL levels were compared between children who received (n=146) and did not receive NSAIDs (n=64). Results The median age was 3.2 years in children who received NSAIDs and 2.5 years in children who did not receive NSAIDs (p=0.05). Prior to NSAID administration at 24 hours following CPB, median NGAL levels were 15 ng/ml in both groups (p=0.92). Following NSAID administration, median urinary NGAL levels increased to 83 ng/ml (IQR 45–95) at 72 hours after CPB in those receiving NSAIDs (p<0.001). In contrast, NGAL levels decreased to 10 ng/ml (IQR 5.4–15.9) at 72 hours after CPB in those who did not receive NSAIDs (p=0.01). In multivariable analysis, children receiving NSAIDs demonstrated a 5-fold elevation of urinary NGAL levels at 60–72 hours following CPB compared with children who did not receive NSAIDs (p<0.001). Conclusion NSAID administration was associated with a significant increase in urinary NGAL following CPB in children who did not develop clinical AKI. This indicates NGAL can detect NSAID-induced subclinical kidney injury in this population.

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Section: Discussionmentioning

confidence: 68%

Subclinical Kidney Injury in Children Receiving Nonsteroidal Anti-Inflammatory Drugs After Cardiac Surgery

Nehus

Kaddourah

Bennett

et al. 2017

The Journal of Pediatrics

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“…Oral NSAIDs is the most common route of administration. However, the use of oral NSAIDs may lead to gastrointestinal, cardiovascular and renal adverse events (9)(10)(11)(12)(13). Loxoprofen sodium (LX), a non-selective NSAID, has a particularly high risk of gastrointestinal disorders.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of loxoprofen hydrogel patch versus loxoprofen tablet in patients with ankylosing spondylitis: A 4‑week randomized, open‑label study

Fan

Cao

et al. 2019

biom rep

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The aim of the present study was to assess the efficacy and safety of loxoprofen sodium hydrogel patch (LX-P) vs. loxoprofen sodium tablet (LX-T) in patients with active ankylosing spondylitis (AS). The study population consisted of patients who met the modified New York radiographic criteria for AS and had active disease. Patients were randomly assigned to either the LX-P group (LX-P 100 mg per day) or LX-T group (LX-T 60 mg 3 times daily) for 4 weeks. The primary efficacy endpoint was the percentage of patients reaching Assessment in Ankylosing Spondylitis 20% (ASAS20) response at week 4. Secondary efficacy outcomes included ASAS5/6 response rate and changes from baseline to week 4 for Ankylosing Spondylitis Disease Activity Score, patient's global assessment of disease activity, and pain score. Of the 70 randomized patients included, 35 patients were allocated to the LX-P group and 35 to the LX-T group. No significant differences were observed between the LX-P and LX-T groups in the proportion of patients achieving ASAS20 response at week 4 (54.3 vs. 74.3%; P= 0.081), nor in the ASAS5/6 response and changes of efficacy outcomes between the two groups. Furthermore, patients without peripheral arthritis in the LX-P group were more likely to achieve ASAS20 response. There was a decreased incidence of gastrointestinal adverse events in the LX-P group, but this was not significant. There was no significant differences in efficacy and safety between topical LX-P and oral LX-T administration for patients with active AS.

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“…Along with opioid-sparing effects, NSAIDs are associated with negative effects such as possible increased risk of bleeding and acute renal failure (Blouin & Rhainds, 2014;Shukla, Rai, Prasad, & Agarwal, 2017;Van Koughnett & Wexner, 2014;Warth et al, 2016). Patients should be carefully evaluated for potential risks for adverse events with NSAIDs.…”

Section: Rationalementioning

confidence: 99%

“…It was once thought that antihistamine medications such as diphenhydramine were helpful in treating pain and reducing postoperative nausea and vomiting (Lin et al, 2005;Tu et al, 2006). More recent evidence has led clinicians to be concerned about the synergistic effects resulting in OIUAS and OIRD when antihistamines are added to opioid regimens (Becker, 2012;Siddik-Sayyid et al, 2010). Unfortunately, there is not strong evidence to substantiate this assumption.…”

Section: Rationalementioning

confidence: 99%

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Jungquist

Quinlan-Colwell

Vallerand

et al. 2020

Pain Management Nursing

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a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

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Short-Term Non-Steroid Anti-Inflammatory Drug Use in Spondyloarthritis Patients Induces Subclinical Acute Kidney Injury: Biomarkers Study

Cited by 20 publications

References 39 publications

Subclinical Kidney Injury in Children Receiving Nonsteroidal Anti-Inflammatory Drugs After Cardiac Surgery

Subclinical Kidney Injury in Children Receiving Nonsteroidal Anti-Inflammatory Drugs After Cardiac Surgery

Efficacy and safety of loxoprofen hydrogel patch versus loxoprofen tablet in patients with ankylosing spondylitis: A 4‑week randomized, open‑label study

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

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