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Nonsteroidal anti-inflammatory drug use and risk of acute kidney injury and hyperkalemia in older adults: a population-based study.
- Source :
-
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2019 Jul 01; Vol. 34 (7), pp. 1145-1154. - Publication Year :
- 2019
-
Abstract
- Background: Clinical guidelines caution against nonsteroidal anti-inflammatory drug (NSAID) use in older adults. The study objective was to quantify the 30-day risk of acute kidney injury (AKI) and hyperkalemia in older adults after NSAID initiation and to develop a model to predict these outcomes.<br />Methods: We conducted a population-based retrospective cohort study in Ontario, Canada from 2007 to 2015 of patients ≥66 years. We matched 46 107 new NSAID users with 46 107 nonusers with similar baseline health. The primary outcome was 30-day risk of AKI and secondary outcomes were hyperkalemia and all-cause mortality.<br />Results: NSAID use versus nonuse was associated with a higher 30-day risk of AKI {380 [0.82%] versus 272 [0.59%]; odds ratio (OR) 1.41 [95% confidence interval (CI) 1.20-1.65]} and hyperkalemia [184 (0.40%) versus 123 (0.27%); OR 1.50 (95% CI 1.20-1.89); risk difference 0.23% (95% CI 0.13-0.34)]. There was no association between NSAID use and all-cause mortality. A prediction model incorporated six predictors of AKI or hyperkalemia: older age, male gender, lower baseline estimated glomerular filtration rate, higher baseline serum potassium, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use or diuretic use. This model had moderate discrimination [C-statistic 0.72 (95% CI 0.70-0.74)] and good calibration.<br />Conclusions: In older adults, new NSAID use compared with nonuse was associated with a higher 30-day risk of AKI and hyperkalemia but not all-cause mortality. Prescription NSAID use among many older adults may be safe, but providers should use caution and assess individual risk.<br /> (© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
- Subjects :
- Acute Kidney Injury epidemiology
Acute Kidney Injury physiopathology
Age Factors
Aged
Cause of Death trends
Female
Follow-Up Studies
Glomerular Filtration Rate drug effects
Humans
Hyperkalemia blood
Hyperkalemia epidemiology
Incidence
Male
Middle Aged
Ontario epidemiology
Potassium blood
Prognosis
Retrospective Studies
Risk Factors
Survival Rate trends
Acute Kidney Injury chemically induced
Anti-Inflammatory Agents, Non-Steroidal adverse effects
Hyperkalemia chemically induced
Risk Assessment methods
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2385
- Volume :
- 34
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Publication Type :
- Academic Journal
- Accession number :
- 31264694
- Full Text :
- https://doi.org/10.1093/ndt/gfz062