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Consumption of non‐steroidal anti‐inflammatory drugs and the development of functional renal impairment in elderly subjects. Results of a case‐control study
Author(s) -
Henry David,
Page John,
Whyte Ian,
Nanra Ranjit,
Hall Christopher
Publication year - 1997
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1046/j.1365-2125.1997.00631.x
Subject(s) - medicine , pharmacology , renal function , intensive care medicine
Aims The aim of the present study was to explore the level of risk associated with community use of non‐steroidal anti‐inflammatory drugs (NSAIDs). Methods We carried out a matched case‐control study of the relationship between recent use of NSAIDs and the presence of functional renal impairment present at the time of hospitalisation with a range of clinical problems. Cases (n=110) were consecutive patients admitted acutely to hospital who had serum creatinine levels greater than or equal to 0.15 mmol l −1 , which improved by 20% or more within the next 14 days, or prior to discharge from hospital. Controls (n=189) were subjects of the same sex and age (to within 5 years) as the cases, who were admitted to the same hospital, who had normal serum creatinine levels (<0.12 mmol l −1 ) throughout their hospital stay . Information on a number of study factors, including recent use of aspirin and other NSAIDs, was obtained by structured interview. Results Overall, there was a weak association between consumption of NSAIDs (including non‐prophylactic aspirin) and the development of functional renal impairment—adjusted odds ratios (OR) with use of NSAIDs in the previous week or in the previous month: OR 1.5 (95% CI 0.80, 2.9) and 1.8 (95% CI 0.97, 3.4) respectively. In subjects with a previous history of renal disease the adjusted OR was 6.6 (0.75, 57.8) and in those with a history of gout or hyperuricaemia the OR was 7.2 (1.3, 40.2). There was a weak positive relationship between the dose of drug consumed in the previous week and the odds of functional renal impairment. The relationship between risk and published figures for drug half‐lives (t ½ ) was stronger. The odds ratio increased from 1.2 (95% CI 0.61, 2.4) with a t ½ ≤4 h, to 4.8 (1.5, 15.8) with a t ½ of ≤12 h (P =0.012, test for trend). This relationship remained statistically significant after adjustment for a number of clinical variables and the dose of drug ingested. Conclusions NSAIDs are an important cause of functional renal impairment in subjects with renal disease or a history of gout or hyperuricemia. The half‐life of the drug is more important than the ingested dose in determining the risk of this outcome. Long half‐life drugs should be avoided in individuals who are at risk of developing renal impairment.