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Selective and non‐selective non‐steroidal anti‐inflammatory drugs and the risk of acute kidney injury
Author(s) -
Lafrance JeanPhilippe,
Miller Donald R.
Publication year - 2009
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.1798
Subject(s) - medicine , rofecoxib , celecoxib , naproxen , acute kidney injury , odds ratio , meloxicam , aspirin , diclofenac , pharmacoepidemiology , retrospective cohort study , ibuprofen , piroxicam , creatinine , pharmacology , cyclooxygenase , biochemistry , chemistry , alternative medicine , pathology , medical prescription , enzyme
Purpose Use of non‐steroidal anti‐inflammatory drugs (NSAID) is associated with risk of acute kidney injury (AKI). Risk of AKI may vary with selectivity of the NSAID, but this has not been studied in a large cohort where AKI was assessed directly from laboratory data. The objective was to compare AKI risk between selective and non‐selective NSAIDs using a laboratory‐based definition of AKI. Methods We conducted a retrospective nested case‐control study in the U.S. Department of Veterans Affairs health care system. From a cohort of 1 459 271 new NSAID users, we identified 22 824 cases of AKI (97% male; mean age: 63 years), and 336 734 matched controls between 2000 and 2006. AKI was defined as a creatinine increase of greater than 50%. Results We found higher risk of AKI in new users of any single NSAID (adjusted odds ratio = 1.82; 95%CI: 1.68, 1.98) compared to non‐users without recent use. The risk of AKI varied among different NSAIDs with risk generally increasing with decrease in selectivity: rofecoxib (0.95; 0.64, 1.42), celecoxib (0.96; 0.63, 1.47), meloxicam (1.13; 0.63, 2.05), etodolac (1.31; 1.08, 1.59), diclofenac (1.11; 0.84, 1.48), piroxicam (1.53; 1.05, 2.23), salsalate (1.51; 1.22, 1.87), sulindac (1.61; 1.12, 2.30), ibuprofen (2.25, 2.04, 2.49), naproxen (1.72; 1.52, 1.95), high dose aspirin (3.64; 2.46, 5.37), indomethacin (1.94; 1.56, 2.42), keterolac (2.07; 1.78, 2.41). Those using multiple NSAIDs appeared to have higher risk (2.90; 2.62, 3.22). Conclusions This study provides evidence that risk of AKI may be lower with more selective agents than with naproxen or other non‐selective NSAIDs. Copyright © 2009 John Wiley & Sons, Ltd.