Abstract
BackgroundNon-steroidal anti-inflammatory agents (NSAIDs) are known to be associated with renal damage. No clear evidence exists regarding differential risk of chronic kidney disease (CKD), specifically, across various NSAIDs.AimThe aim of this population-based case-control study was to evaluate the association between use of individual NSAIDs and risk of CKD in a general population of Southern Italy.MethodsA nested case-control study was carried out using the general practice Arianna database, identifying incident CKD patients as cases and matched controls from 2006 to 2011. The date of first CKD diagnosis was defined as the index date (ID). Conditional logistic regressions were performed to estimate the risk of CKD associated with NSAIDs by class and individual drugs as compared to non-use during different time windows (within one year, six or three months prior to ID), with the latter being defined as current users. Among current users, the effect of cumulative exposure to these drugs was evaluated.ResultsOverall, 1,989 CKD cases and 7,906 matched controls were identified. A statistically significant increase in the risk of CKD was found for current users of oxicams (adjusted OR: 1.68; 95% CI: 1.15-2.44) and concerning individual compounds, for ketorolac (adj. OR: 2.54; 95% CI: 1.45-4.44), meloxicam (adj. OR: 1.98; 95% CI: 1.01-3.87) and piroxicam (adj. OR: 1.95; 95% CI: 1.19-3.21).ConclusionsThe risk of CKD varies across individual NSAIDs. Increased risk has been found for ketorolac, which may precipitate subclinical CKD through acute renal damage, and long-term exposure to oxicams, especially meloxicam and piroxicam.
Highlights
Chronic kidney disease (CKD) represents an important cause of morbidity and mortality worldwide [1, 2]
The risk of chronic kidney disease (CKD) varies across individual non-steroidal anti-inflammatory drugs (NSAIDs)
Increased risk has been found for ketorolac, which may precipitate subclinical CKD through acute renal damage, and long-term exposure to oxicams, especially meloxicam and piroxicam
Summary
Chronic kidney disease (CKD) represents an important cause of morbidity and mortality worldwide [1, 2]. The main underlying factors driving the progressively increasing prevalence of CKD are the ageing of global populations [5], the global epidemic of type 2 diabetes mellitus [6] and other co-morbidities such as hypertension [3, 7,8,9]. Several drugs which are widely used in general population [10] such as non-steroidal anti-inflammatory drugs (NSAIDs) can affect renal function [11, 12]. NSAIDs are commonly known to cause acute kidney injury (AKI) through multiple mechanisms, accounting for 16% of all drug-related renal failure [13]. No clear evidence exists regarding differential risk of chronic kidney disease (CKD), across various NSAIDs
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