Abstract
BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been linked to acute kidney injury (AKI), chronic kidney disease (CKD) and cardiovascular disease (CVD). Patients who survive an AKI episode are at risk for future adverse kidney and cardiovascular outcomes. The objective of our study was to examine the prevalence and predictors of NSAID use among AKI survivors.MethodsThe Southern Community Cohort Study is a prospective study of low-income adults aged 40–79 in the southeastern US. Through linkage with Centers for Medicare and Medicaid Services, 826 participants with an AKI diagnosis (ICD-9 584.5-584.9) at any age prior to cohort enrollment were identified. At baseline, data were collected on regular use of prescription and over-the-counter NSAIDs, as well as demographic, medical and other characteristics. Additional comorbidities were ascertained via linkage with CMS or the US Renal Data System.ResultsOne hundred fifty-four AKI survivors (19%) reported regular NSAID use at cohort enrollment (52 prescription, 81 OTC, 21 both) and the percentage of NSAID users did not vary by time since AKI event. Over 58% of users were taking NSAIDS regularly both before and after their AKI event. Hypertension (83%), arthritis (71%), heart failure (44%), CKD (36%) and diabetes (35%) were prevalent among NSAID users. In a multivariable model, history of arthritis (OR: 3.00; 95% CI: 1.92, 4.68) and acetaminophen use (OR: 2.43; 95% CI: 1.50, 3.93) were significantly associated with NSAID use, while prevalent CKD (OR: 0.63; 95% CI: 0.41, 0.98) and diabetes (OR: 0.44; 95% CI: 0.29, 0.69) were significantly inversely associated.ConclusionsNSAID use among AKI survivors is common and highlights the need to understand physician and patient decision-making around NSAIDs and to develop effective strategies to reduce NSAID use in this vulnerable population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0411-7) contains supplementary material, which is available to authorized users.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been linked to acute kidney injury (AKI), chronic kidney disease (CKD) and cardiovascular disease (CVD)
The American Society of Nephrology (ASN) Quality and Patient Safety (QPS) Task Force highlighted the avoidance of NSAIDs as a high priority area “most open” to improvement in patients with kidney disease [8]
Despite growing attention to the dangers of NSAID use among high-risk populations, use is common among patients with CKD, ranging between 4–31% depending on the populations studied [10, 11]
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been linked to acute kidney injury (AKI), chronic kidney disease (CKD) and cardiovascular disease (CVD). Improving outcomes among the growing population of AKI survivors requires identifying modifiable risk factors to reduce these events. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used analgesics worldwide and an established risk factor for AKI [4, 5], chronic kidney disease (CKD) [6], and CVD [7]. Given the high prevalence of CKD in this population and evidence linking AKI to future kidney and cardiovascular outcomes [12, 13], examining NSAID use among survivors of AKI is important for identifying the magnitude of the gap between patient and provider practice and guideline recommendations. To examine the frequency of NSAID use among AKI survivors in a low socioeconomic population which carries a disproportionate risk of CKD and end-stage renal disease [14], as well as factors associated with NSAID use among AKI survivors, we leveraged detailed analgesic intake information collected from participants in the Southern Community Cohort Study (SCCS), a large prospective cohort of low-income adults in the southeastern US
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