NSAID use is linked to acute kidney injury in elderly patients

  • Nash DM & al.
  • Nephrol Dial Transplant
  • 1 Jul 2019

  • International Clinical Digest
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Takeaway

  • New prescription NSAID use among older adults is associated with elevated short-term risk for acute kidney injury (AKI) and hyperkalaemia but not all-cause mortality.

Why this matters

  • Prescription NSAIDs should be used with caution among older patients.

Study design

  • Population-based Canadian study of patients aged ≥66 years.
  • 46,107 new NSAID users, matched with 46,107 nonusers based on baseline health (mean age, 74.2±7.1 years; hypertension, 74.6%-74.9%).
  • Funding: ICES Western site.

Key results

  • 30-day AKI rate was higher with new NSAID use vs nonuse (0.82% vs 0.59%), corresponding with 41% increased likelihood (OR, 1.41; 95% CI, 1.20-1.65).
    • Association was consistent across AKI stages,
    • Number needed to harm: 427 (95% CI, 292-787), and
    • No significant effect for baseline renal function (P=1.0), use of angiotensin receptor blockers or angiotensin converting enzyme inhibitors (P=.9) or diuretics (P=.1), or NSAID dose (P=.2).
  • 30-day hyperkalaemia rate was also higher with NSAIDs (0.40% vs 0.27%), corresponding to 50% higher odds (OR, 1.50; 95% CI, 1.20-1.89).
    • Number needed to harm: 756 (95% CI, 485-1715).
  • No association between NSAID use and all-cause mortality.

Limitations

  • Retrospective design.
  • Over-the-counter use not captured.

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