NSAID exposure tied to AKI, CKD in active younger adults

  • Nelson DA & al.
  • JAMA Netw Open
  • 1 Feb 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • High NSAID exposure is tied to increased risks for acute kidney injury (AKI) and chronic kidney disease (CKD) among active younger and middle-aged adults.

Why this matters

  • Lower doses may be beneficial for civilians with strenuous, potentially dehydration-producing occupations.

Study design

  • Retrospective study of 764,228 active-duty US Army soldiers (mean age, 28.6±7.9 years; 85.8% men) serving between 2011 and 2014; analysis conducted in 2018.
  • Funding: National Heart, Lung, and Blood Institute; Uniformed Services University of the Health Sciences.  

Key results

  • 17.9% were dispensed 1-7 mean total defined daily doses (DDD) monthly.
  • 16.3% received >7 DDD/month.
  • Over a median 2.4 person-years, 0.3% developed AKI and 0.2% developed CKD.
  • NSAID exposure >7 DDD/month (vs none) was tied to a 20% increased risk for AKI (aHR=1.2; 95% CI, 1.1-1.4) and CKD (aHR=1.2; 95% CI, 1.0-1.3).
    • 17.6 and 30.0 excess AKI and CKD cases, respectively, per 100,000 persons/year.
  • Compared with whites, African-Americans had higher risks for AKI (aHR=1.6; 95% CI, 1.4-1.7) and CKD (aHR=2.3; 95% CI, 2.0-2.5).
  • Male sex was tied to increased risks for AKI (aHR=2.3; 95% CI, 2.0-2.7) and CKD (aHR=1.6; 95% CI, 1.4-1.9).
  • Risk increased with age >22 years, particularly for CKD.

Limitations

  • Reliance on diagnostic codes.
  • Over-the-counter use not captured.
  • Population prone to intermittent dehydration.

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