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Karri J, D'Souza RS, Wang EJ. Cyclooxygenase-2 Selective Nonsteroidal Anti-Inflammatory Drugs in the Chronic Kidney Disease Population: Are They Rational or Reckless? Anesth Analg 2024; 139:235-237. [PMID: 38381665 DOI: 10.1213/ane.0000000000006574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Jay Karri
- From the Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Hall RK, Kazancıoğlu R, Thanachayanont T, Wong G, Sabanayagam D, Battistella M, Ahmed SB, Inker LA, Barreto EF, Fu EL, Clase CM, Carrero JJ. Drug stewardship in chronic kidney disease to achieve effective and safe medication use. Nat Rev Nephrol 2024; 20:386-401. [PMID: 38491222 DOI: 10.1038/s41581-024-00823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
People living with chronic kidney disease (CKD) often experience multimorbidity and require polypharmacy. Kidney dysfunction can also alter the pharmacokinetics and pharmacodynamics of medications, which can modify their risks and benefits; the extent of these changes is not well understood for all situations or medications. The principle of drug stewardship is aimed at maximizing medication safety and effectiveness in a population of patients through a variety of processes including medication reconciliation, medication selection, dose adjustment, monitoring for effectiveness and safety, and discontinuation (deprescribing) when no longer necessary. This Review is aimed at serving as a resource for achieving optimal drug stewardship for patients with CKD. We describe special considerations for medication use during pregnancy and lactation, during acute illness and in patients with cancer, as well as guidance for the responsible use of over-the-counter drugs, herbal remedies, supplements and sick-day rules. We also highlight inequities in medication access worldwide and suggest policies to improve access to quality and essential medications for all persons with CKD. Further strategies to promote drug stewardship include patient education and engagement, the use of digital health tools, shared decision-making and collaboration within interdisciplinary teams. Throughout, we position the person with CKD at the centre of all drug stewardship efforts.
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Affiliation(s)
- Rasheeda K Hall
- Division of Nephrology, Department of Medicine, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | | | - Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Catherine M Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, and Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
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3
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Schrag TA, Diarra D, Veser J. Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population. Curr Opin Urol 2024; 34:154-165. [PMID: 38445376 DOI: 10.1097/mou.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE OF REVIEW Purpose of the review is to address management and prevention of urolithiasis in elderly patients examining the dynamic interplay between general measures, dietary adjustments, lifestyle modifications, and targeted pharmacological and/ or surgical interventions. The goal is to provide understanding of the evolving strategies required for effective urolithiasis prevention in the geriatric population. RECENT FINDINGS Age-specific diagnostic considerations are necessary because urolithiasis in the elderly population is characterized by bigger stones, greater peri-operative risks, and heightened symptom severity. When comorbidities are present, conservative treatments - especially analgesia - provide difficulties. Surgical procedures prove to be safe and effective, with complication rates and practical application comparable to younger cohorts. Prevention approaches that include lifestyle changes and the investigation of novel pharmaceutical options such as sodium-dependent glucose co-transporter 2 (SGLT-2)-inhibitors are promising in the management of urolithiasis in the elderly population. SUMMARY Our review offers a thorough investigation of urolithiasis in the elderly population, elucidating distinct clinical manifestations, complex diagnostic issues, and treatment implications. The safety and effectiveness of ureteroscopy in older patients, as well as the possible prophylactic function of SGLT-2-I, offer crucial insights for clinicians. Subsequent studies are necessary to enhance age-specific therapies, addressing the distinct obstacles presented by urolithiasis in the elderly population within this rapidly growing demographic.
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4
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Kannuthurai V, Gaffo A. Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps. KIDNEY360 2023; 4:e1332-e1340. [PMID: 37526648 PMCID: PMC10550007 DOI: 10.34067/kid.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
Gout, a common form of inflammatory arthritis, is characterized by deposition of monosodium urate crystals in articular and periarticular tissues. Repeated flares of gout cause joint damage as well as significant health care utilization and decreased quality of life. Patients with CKD have a higher prevalence of gout. Treating Patients with CKD and gout is challenging because of the lack of quality data to guide management in this specific population. This often leads to suboptimal treatment of patients with gout and impaired renal function because concerns regarding the efficacy and safety of available gout therapies in this population often result in significant interphysician variability in treatment regimens and dosages. Acute gout flares are treated with various agents, including nonsteroidal anti-inflammatory drugs, colchicine, glucocorticoids, and-more recently-IL-1 inhibitors. These medications can also be used as prophylaxis if urate-lowering therapy (ULT) is initiated. While these drugs can be used in patients with gout and CKD, there are often factors that complicate treatment, such as the numerous medication interactions involving colchicine and the effect of glucocorticoids on common comorbidities, such as diabetes and hypertension. ULT is recommended to treat recurrent flares, tophaceous deposits, and patients with moderate-to-severe CKD with a serum urate goal of <6 mg/dl recommended to prevent flares. While many misconceptions exist around the risks of using urate-lowering agents in patients with CKD, there is some evidence that these medications can be used safely in Patients with renal impairment. Additional questions exist as to whether gout treatment is indicated for Patients on RRT. Furthermore, there are conflicting data on whether ULT can affect renal function and cardiovascular disease in patients. All of these factors contribute to the unique challenges physicians face when treating patients with gout and CKD.
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Affiliation(s)
- Vijay Kannuthurai
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Angelo Gaffo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Birmingham VA Medical Center, Birmingham, Alabama
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6
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Acute Kidney Injury in a Cohort of Critical Illness Patients Exposed to Non-Steroidal Anti-Inflammatory Drugs. Pharmaceuticals (Basel) 2022; 15:ph15111409. [PMID: 36422539 PMCID: PMC9693114 DOI: 10.3390/ph15111409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
To determine whether non-steroidal anti-inflammatory drug (NSAIDs) exposure prior to intensive care unit (ICU) admission affects the development of acute kidney injury (AKI) with renal replacement therapy (RRT). An administrative database is used to establish a cohort of patients who were admitted to the ICU. The exposure to NSAIDs that the patients had before admission to the ICU is determined. Demographic variables, comorbidities, AKI diagnoses requiring RRT, and pneumonia during the ICU stay are also measured. Multivariate logistic regression and inverse probability weighting (IPW) are used to calculate risks of exposure to NSAIDs for patients with AKI requiring RRT. In total, 96,235 patients were admitted to the ICU, of which 16,068 (16.7%) were exposed to NSAIDs. The incidence of AKI with RRT was 2.71% for being exposed to NSAIDs versus 2.24% for those not exposed (p < 0.001). For the outcome of AKI, the odds ratio weighted with IPW was 1.28 (95% CI: 1.15−1.43), and for the outcome of pneumonia as a negative control, the odds ratio was 1.07 (95% CI: 0.98−1.17). The impact of prior exposure to NSAIDs over critically ill patients in the development of AKI is calculated as 8 patients per 1000 exposures. The negative control with the same sources of bias did not show an association with NSAID exposure.
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7
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Hung CW, Zhang TS, Harrington MA, Halawi MJ. Incidence and risk factors for acute kidney injury after total joint arthroplasty. ARTHROPLASTY 2022; 4:18. [PMID: 35501928 PMCID: PMC9063071 DOI: 10.1186/s42836-022-00120-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is one of the most common medical causes for readmission following total joint arthroplasty (TJA). This study aimed to (1) examine whether the incidence of AKI has changed over the past decade with the adoption of modern perioperative care pathways and (2) identify the risk factors and concomitant adverse events (AEs) associated with AKI. METHODS 535,291 primary TJA procedures from the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2018 were retrospectively reviewed. The annual incidence of AKI was analyzed for significant changes over time. Matched cohort analyses were performed to identify the risk factors and AEs associated with AKI using multivariate logistic regression. RESULTS The mean incidence of AKI was 0.051%, which remained unchanged during the study period (P = 0.121). Factors associated with AKI were diabetes (OR 1.96, P = 0.009), bilateral procedure (OR 6.93, P = 0.030), lower preoperative hematocrit level (OR 1.09, P = 0.015), body mass index (OR 1.04, P = 0.025), and higher preoperative BUN (OR 1.03, P = 0.043). AKI was associated with length of stay (LOS) > 2 days (OR 4.73, P < 0.001), non-home discharge (OR 0.25, P < 0.001), 30-day readmission (OR 12.29, P < 0.001), and mortality (OR 130.7, P < 0.001). CONCLUSIONS The incidence of AKI has not changed over the past decade, and it remains a major bundle buster resulting in greater LOS, non-home discharge, readmissions, and mortality. Avoidance of bilateral TJA in patients with DM and high BMI as well as preoperative optimization of anemia and BUN levels are advised.
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Affiliation(s)
- Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Melvyn A Harrington
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Mohamad J Halawi
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
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8
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Hung CW, Riggan ND, Hunt TR, Halawi MJ. What's Important: A Rallying Call for Nonsteroidal Anti-Inflammatory Drugs in Musculoskeletal Pain: Improving Value of Care While Combating the Opioid Epidemic. J Bone Joint Surg Am 2022; 104:659-663. [PMID: 34437306 DOI: 10.2106/jbjs.21.00466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chun Wai Hung
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Thomas R Hunt
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Mohamad J Halawi
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
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Abstract
ABSTRACT Severe pain and urinary tract obstruction are hallmarks of renal calculi often requiring hospitalization and treatment. Renal damage can occur without proper intervention. This article discusses the role of nurses in caring for patients with renal calculi, current treatment approaches, and prevention strategies.
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Affiliation(s)
- Tammie J Coffman
- At Texas Tech University Health Sciences Center School of Nursing, Tammie J. Coffman and Amy Boothe are assistant professors, and Jeff Watson is an associate professor
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Corona AG, Garcia P, Gelfand SL. Palliative Care for Patients With Cancer and Kidney Disease. Adv Chronic Kidney Dis 2022; 29:201-207.e1. [PMID: 35817527 DOI: 10.1053/j.ackd.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/11/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022]
Abstract
Patients with cancer and kidney disease experience a range of symptoms that impact their quality of life. Pain, fatigue, decreased appetite, and depression are all common in this population. Kidney palliative care is patient-centered medical care focused on reducing symptoms and defining individualized goals of care for patients and their families. Pharmacologic management of pain in patients with cancer and kidney disease requires recognition of the type of pain, its cause, and the risks and benefits of different medication classes. This review describes basic symptom management options as well as considerations for discussing goals of care, prognosis, and end of life.
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Affiliation(s)
- Antonio G Corona
- Division of Geriatrics and Palliative Medicine, Northwell Health, Great Neck, NY; Division of Nephrology, Northwell Health, Great Neck, NY
| | - Pablo Garcia
- Division of Nephrology, Stanford Medicine, Stanford, CA
| | - Samantha L Gelfand
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Sheth S, Thakur S, Thorat A, Gupta P. Safe and appropriate use of diclofenac in chronic kidney disease: An Indian perspective. J Family Med Prim Care 2021; 10:2450-2456. [PMID: 34568119 PMCID: PMC8415660 DOI: 10.4103/jfmpc.jfmpc_2358_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/20/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Pain is most common symptom associated with progressive disorder, chronic kidney disease (CKD), and is usually undertreated during the early stages of CKD. So, present review was conducted to evaluate the challenges for the management of pain in CKD patients and addresses the scope for considering Diclofenac as suitable alternative for pain management in CKD patient. The database PubMed and Google Scholar were searched from 1970 to Dec 2020 for literature published in English and all studies, review articles that examined the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in pain management in CKD patients were included. Literatures revealed that there is a considerable challenge in appropriate management of pain in CKD patients include understanding the altered pharmacokinetics and pharmacodynamics of analgesics in CKD patients and the risk of acute interstitial nephritis. The shorter duration of analgesics is acceptable and considered to pose a low risk of acute interstitial nephritis in patients. Considering that Diclofenac has a shorter half-life and high efficacy, it may be well tolerated in patients with CKD. The acceptance of Diclofenac is partly attributed to being a potent COX-2 inhibitor with the lowest IC50 and its rapid onset of action at lowest effective dose. In conclusion, diclofenac may be well tolerated in patients of renal impairment when used at lowest effective dose for shortest dose duration. Diclofenac is worthy of consideration in mild to moderate cases of CKD. For effective pain management, it is vital to evaluate the tolerability and efficacy of the available analgesics critically.
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Affiliation(s)
- Sharad Sheth
- Head of Nephrology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Sneha Thakur
- Medical Advisor, Novartis India Limited, Mumbai, Maharashtra, India
| | - Anup Thorat
- Franchise Medical Head, Novartis India Limited, Mumbai, Maharashtra, India
| | - Pankaj Gupta
- Head Medical Affairs, Novartis India Limited, Mumbai, Maharashtra, India
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Tang YZ, Zeng P, Liao Y, Qin Z, Zhang H, Li B, Ouyang W, Li D. Correlation between perioperative parecoxib use and postoperative acute kidney injury in patients undergoing non-cardiac surgery: a retrospective cohort analysis. BMJ Open 2021; 11:e047840. [PMID: 34433595 PMCID: PMC8388276 DOI: 10.1136/bmjopen-2020-047840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The association of non-steroidal anti-inflammatory drugs with postoperative acute kidney injury (AKI) is controversial. However, there are few studies focusing on the association between parecoxib and postoperative AKI. Our study aimed at the possible correlation between the intraoperative administration of cyclooxygenase-2 inhibitors parecoxib and perioperative AKI. DESIGN A retrospective cohort study. SETTING Third Xiangya Hospital of Central South University in Hunan Province, China. PARTICIPANTS The electronic medical records and laboratory results were obtained from 9246 adult patients (18-60 years) undergoing non-cardiac surgery performed between 1 January 2012 and 31 August 2017. Study groups were treated with or without parecoxib. INTERVENTIONS Univariable analysis identified demographic, preoperative laboratory and intraoperative factors associated with AKI. Logistic stepwise regression was used to calculate the adjusted OR of parecoxib and AKI association. RESULTS The incidence of AKI was lower in the parecoxib-administered group (4%) than that in the group without parecoxib (6.3%, p=0.005). In the multivariable regression analysis, postoperative AKI risk reduced by 39% (OR 0.61; 95% CI 0.43 to 0.87) in the parecoxib-administered group after adjusting for interference factors. Sensitivity analysis showed that postoperative AKI risk reduced in four subgroups: eGRF <90 mL/min·1.73/m2 (OR 0.49; 95% CI 0.29 to 0.82), non-smoker (OR 0.55; 95% CI 0.37 to 0.83), blood loss <1000 mL (OR 0.55; 95% CI 0.37 to 0.83) and non-hypotension (OR 0.57; 95% CI 0.38 to 0.84). CONCLUSIONS Thus, parecoxib is associated with a modest reduction of postoperative AKI risk among adult patients undergoing non-cardiac surgery.
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Affiliation(s)
- Yong-Zhong Tang
- Department of Anesthesiology, Central South University Third Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Pingping Zeng
- Department of Anesthesiology, Central South University Third Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Yan Liao
- Department of Anesthesiology, Central South University Third Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Zheng Qin
- Hunan University College of Computer Science and Electronic Engineering, Changsha, Hunan, People's Republic of China
| | - Hao Zhang
- Institute of Microelectronics pf Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Bo Li
- Operation center, Central South University Third Xiangya Hospital, Changsha, People's Republic of China
| | - Wen Ouyang
- Department of Anesthesiology, Central South University Third Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Dan Li
- Department of Anesthesiology, Central South University Third Xiangya Hospital, Changsha, Hunan, People's Republic of China
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13
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Colasanti JA, Vettese T, Samet JH. Improving Outpatient Management of Patients On Chronic Opioid Therapy. Infect Dis Clin North Am 2021; 34:621-635. [PMID: 32782105 DOI: 10.1016/j.idc.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Managing patients with chronic pain on chronic opioid therapy (COT) can be challenging if done mainly by an individual clinician. A stepwise, systematic approach to managing patients on COT includes centering the discussion around safety for the patient. Treatment agreements and monitoring plans are important to safe prescribing. With a team-based care approach programs can be implemented, which optimize the benefits of opioid therapy and mitigate the risk. In these settings COT can be prescribed adhering to current guidelines in order to help achieve pain management, optimize function, and advance the patients' quality of life goals.
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Affiliation(s)
- Jonathan A Colasanti
- Department of Medicine, Division of Infectious Diseases, Emory University, 341 Ponce de Leon Avenue, Atlanta, GA 30308, USA.
| | - Theresa Vettese
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Emory University, 49 Jesse Hill Drive SE #40, Atlanta, GA 30303, USA. https://twitter.com/tracyvettese
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center; 801 Massachusetts Avenue, CT 2, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, CT 2, Boston, MA 02118, USA
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14
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Tang KS, Shah AD. Nonsteroidal anti-inflammatory drugs in end-stage kidney disease: dangerous or underutilized? Expert Opin Pharmacother 2021; 22:769-777. [PMID: 33467933 DOI: 10.1080/14656566.2020.1856369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are a popular class of analgesic and anti-inflammatory medications, but their use is often avoided in end-stage kidney disease (ESKD) patients due to their reputation for nephrotoxic side effects. This removes a useful agent from the analgesic arsenal, even as ESKD patients suffer from proportionally more severe chronic pain than the general population as well as from a large reliance on opioid medications. Areas Covered: This paper reviews the current literature to comprehensively define the pharmacologic mechanisms and adverse effects of NSAIDs and reassesses the viability of their use in ESKD patients. Expert opinion: The evidence directly examining the impact of NSAIDs on long-term outcomes in ESKD is limited. Further study quantifying the risk of NSAID use - especially in dialysis-dependent patients - is warranted. Given the difficulty in achieving adequate pain control in ESKD patients, limited use of NSAIDs in these patients may yet be justified.
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Affiliation(s)
- Kevin S Tang
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ankur D Shah
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Nephrology, Rhode Island Hospital, Providence, RI, USA.,Division of Nephrology, Medical Service, Veterans Affairs Medical Center, Providence, RI, USA
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15
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Amatruda JG, Katz R, Peralta CA, Estrella MM, Sarathy H, Fried LF, Newman AB, Parikh CR, Ix JH, Sarnak MJ, Shlipak MG. Association of Non-Steroidal Anti-Inflammatory Drugs with Kidney Health in Ambulatory Older Adults. J Am Geriatr Soc 2020; 69:726-734. [PMID: 33305369 DOI: 10.1111/jgs.16961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Non-steroidal anti-inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine-based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. DESIGN Cross-sectional and longitudinal analyses. SETTING Multicenter, community-based cohort. PARTICIPANTS Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. EXPOSURE Prescription and over-the-counter NSAID use ascertained by self-report. MEASUREMENTS Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin-to-creatinine ratio (ACR), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) were measured in 2,999 participants; alpha-1 microglobulin (α1m), neutrophil gelatinase-associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. RESULTS Participants had a mean age of 74 years, 51% were female, and 41% African-American. No eGFR differences were detected between NSAID users (n = 655) and non-users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non-users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51-0.89) and lower mean urine IL-18 concentration at baseline (-11%; 95% CI = -4% to -18%), but similar mean KIM-1 (5%; 95% CI = -5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non-users did not differ significantly in the rate of eGFR decline (-2.2% vs -2.3% per year). CONCLUSION Self-reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption.
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Affiliation(s)
- Jonathan G Amatruda
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco, San Francisco, California, USA
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Carmen A Peralta
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco, San Francisco, California, USA.,Chief Medical Office, Cricket Health, Inc., San Francisco, California, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco, San Francisco, California, USA.,Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Harini Sarathy
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Division of Nephrology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Linda F Fried
- University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anne B Newman
- University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, California, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco VA Medical Center & University of California, San Francisco, San Francisco, California, USA.,Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
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16
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Fragoulis GE, Panayotidis I, Nikiphorou E. Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment. Curr Vasc Pharmacol 2020; 18:431-446. [PMID: 31258091 DOI: 10.2174/1570161117666190619143842] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 12/19/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.
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Affiliation(s)
- George E Fragoulis
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Ismini Panayotidis
- Faculty of Medical Sciences, Medical School, University College London, London, United Kingdom
| | - Elena Nikiphorou
- Department of Inflammation Biology, King's College London, London, UK and Department of Rheumatology, King's College Hospital, London, United Kingdom
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17
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Roy PJ, Weltman M, Dember LM, Liebschutz J, Jhamb M. Pain management in patients with chronic kidney disease and end-stage kidney disease. Curr Opin Nephrol Hypertens 2020; 29:671-680. [PMID: 32941189 PMCID: PMC7753951 DOI: 10.1097/mnh.0000000000000646] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review evaluates current recommendations for pain management in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) with a specific focus on evidence for opioid analgesia, including the partial agonist, buprenorphine. RECENT FINDINGS Recent evidence supports the use of physical activity and other nonpharmacologic therapies, either alone or with pharmacological therapies, for pain management. Nonopioid analgesics, including acetaminophen, topical analgesics, gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and TCA may be considered based on pain cause and type, with careful dose considerations in kidney disease. NSAIDs may be used in CKD and ESKD for short durations with careful monitoring. Opioid use should be minimized and reserved for patients who have failed other therapies. Opioids have been associated with increased adverse events in this population, and thus should be used cautiously after risk/benefit discussion with the patient. Opioids that are safer to use in kidney disease include oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Buprenorphine appears to be a promising and safer option due to its partial agonism at the mu opioid receptor. SUMMARY Pain is poorly managed in patients with kidney disease. Nonpharmacological and nonopioid analgesics should be first-line approaches for pain management. Opioid use should be minimized with careful monitoring and dose adjustment.
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Affiliation(s)
- Payel Jhoom Roy
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Melanie Weltman
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | - Laura M. Dember
- Renal, Electrolyte and Hypertension Division, Department of Medicine, and Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine
| | - Jane Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Manisha Jhamb
- Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh
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18
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Barreto EF, Feely MA. Can NSAIDs be used safely for analgesia in patients with CKD?: PRO. ACTA ACUST UNITED AC 2020; 1:1184-1188. [PMID: 34296195 DOI: 10.34067/kid.0004582020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Erin F Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Molly A Feely
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN
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19
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Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, Mokhtar SA, Nakata K, Navarra SV, Nguyen VH, Pinzon R, Tsuruoka S, Yim HB, Choy E. Practice Advisory on the Appropriate Use of NSAIDs in Primary Care. J Pain Res 2020; 13:1925-1939. [PMID: 32821151 PMCID: PMC7422842 DOI: 10.2147/jpr.s247781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.
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Affiliation(s)
- Kok Yuen Ho
- The Pain Clinic, Mt Alvernia Hospital, Singapore
| | | | - Sumapa Chaiamnuay
- Rheumatic Disease Unit, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Rudy Hidayat
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | | | - Ozlan Kamil
- Gleneagles Hospital, Kuala Lumpur, Malaysia.,Prince Court Medical Center, Kuala Lumpur, Malaysia
| | - Sabarul A Mokhtar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sandra V Navarra
- Section of Rheumatology, Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Van Hung Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
| | - Rizaldy Pinzon
- Department of Neurology, Faculty of Medicine, Kristen Duta Wacana University, Bethesda Hospital, Yogyakarta, Indonesia
| | | | - Heng Boon Yim
- Mount Elizabeth Novena Hospital, Singapore.,Faculty of Medicine, National University of Singapore, Singapore
| | - Ernest Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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20
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Vest LS, Sarabu N, Koraishy FM, Nguyen MT, Park M, Lam NN, Schnitzler MA, Axelrod D, Hsu CY, Garg AX, Segev DL, Massie AB, Hess GP, Kasiske BL, Lentine KL. Prescription patterns of opioids and non-steroidal anti-inflammatory drugs in the first year after living kidney donation: An analysis of U.S. Registry and Pharmacy fill records. Clin Transplant 2020; 34:e14000. [PMID: 32502285 PMCID: PMC7449599 DOI: 10.1111/ctr.14000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
We examined a novel database linking national donor registry identifiers to records from a US pharmaceutical claims warehouse (2007-2015) to describe opioid and NSAID prescription patterns among LKDs during the first year postdonation, divided into three periods: 0-14 days, 15-182 days, and 183-365 days. Associations of opioid and NSAID prescription fills with baseline factors were examined by logistic regression (adjusted odds ratio, LCL aORUCL ). Among 23,565 donors, opioid prescriptions were highest during days 0-14 (36.6%), but 12.6% of donors filled opioids during days 183-365. NSAID prescriptions rose from 0.5% during days 0-14 to 3.3% during days 183-365. Women filled opioids more commonly than men, and black donors filled both opioids and NSAIDs more commonly than white donors. After covariate adjustment, significant correlates of opioid prescription fills during days 183-365 included obesity (aOR,1.24 1.381.53 ), less than college education (aOR,1.19 1.311.43 ), smoking (aOR,1.33 1.451.58 ), and nephrectomy complications (aOR,1.11 1.291.49 ). NSAID prescription fills in year 1 were not associated with differences in estimated glomerular filtration rate, incidence of proteinuria or new-onset hypertension at the first and second year postdonation. Prescription fills for opioids and NSAIDs for LKDs varied with demographic and clinic traits. Future work should examine longer-term outcome implications to help inform safe analgesic regimen choices after donation.
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Affiliation(s)
- Luke S Vest
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nagaraju Sarabu
- Nephrology, Department of Medicine, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Farrukh M Koraishy
- Nephrology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Minh-Tri Nguyen
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Meyeon Park
- Nephrology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Ngan N Lam
- Nephrology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - David Axelrod
- University of Iowa Transplant Institute, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Chi Yuan Hsu
- Nephrology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Amit X Garg
- Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Dorry L Segev
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory P Hess
- Drexel University School of Medicine, Philadelphia, PA, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
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21
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Baker M, Perazella MA. NSAIDs in CKD: Are They Safe? Am J Kidney Dis 2020; 76:546-557. [PMID: 32479922 DOI: 10.1053/j.ajkd.2020.03.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Abstract
The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have increased susceptibility to adverse drug effects due to altered drug metabolism and excretion, and there are limited safety data for use in this population despite a high pain burden. Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been regarded as dangerous for use in patients with CKD because of their risk for nephrotoxicity and thus alternative classes of analgesics, including opioids, have become more commonly used for pain control in this population. Given the well-established risks that opioids and other analgesics pose, further characterization of the risk posed by NSAIDs in patients with CKD is warranted. NSAID use has been associated with acute kidney injury, progressive loss of glomerular filtration rate in CKD, electrolyte derangements, and hypervolemia with worsening of heart failure and hypertension. The risk for these nephrotoxicity syndromes is modified by many comorbid conditions, risk factors, and characteristics of use, and in patients with CKD, the risk differs between levels of glomerular filtration rate. In this review, we offer recommendations for the cautious use of NSAIDs in the CKD population after careful consideration of these risk factors on an individualized basis.
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Affiliation(s)
- Megan Baker
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Mark A Perazella
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Medical Center, West Haven, CT.
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22
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Desmarais J, Schwab P. Gout Management in Chronic Kidney Disease: Pearls and Pitfalls. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Rove KO, Brockel MA, Brindle ME, Scott MJ, Herndon CDA, Ljungqvist O, Koyle MA. Embracing change-the time for pediatric enhanced recovery after surgery is now. J Pediatr Urol 2019; 15:491-493. [PMID: 31109886 DOI: 10.1016/j.jpurol.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Affiliation(s)
- K O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado 13123 E. 16th Avenue, B-463 Aurora, CO, USA.
| | - M A Brockel
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - M E Brindle
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M J Scott
- Department of Anesthesiology, Virginia Commonwealth University Healthcare System, Richmond, VA, USA; Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C D A Herndon
- Division of Urology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - O Ljungqvist
- Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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24
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Editorial. Curr Opin Nephrol Hypertens 2019; 28:128-129. [DOI: 10.1097/mnh.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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