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Alshahrani M, Almalki LZ, Hasoosah NA, Alahmari AH, Alqahtani AM, Alqahtani AA, AL Muarfaj AM, Al Ghaseb LS, Alkahtani FS, Alsharif RY. Prevalence and assessment of risk factors of chronic kidney disease in the ASIR region of Saudi Arabia. Ann Med Surg (Lond) 2024; 86:3909-3916. [PMID: 38989199 PMCID: PMC11230802 DOI: 10.1097/ms9.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Chronic kidney disease (CKD) is a major health concern in Saudi Arabia. The prevalence of CKD and associated risk factors in Saudi Arabia's general population are not efficiently studied. The goal of this research is to determine the prevalence rate of CKD in the ASIR region and its associated epidemiological risk factors. Methodology This is a cross-sectional study that used a comprehensive direct questionnaire to collect data on CKD prevalence and risk factors in the ASIR region of Saudi Arabia. The study was carried out in different age groups. Demographic characteristics, presence of CKD, and associated factors such as a history of acute kidney disease, obstructive sleep apnoea, family history, history of non-steroid anti-inflammatory drugs (NSAID), smoking status, comorbidities, and history of periodontal diseases were asked. The survey tool was validated through a pilot study, and a statistical p value of 0.05 was considered significant. Results A total of 967 participants were included in the study, with a CKD prevalence rate of 1.9%. Sex, history of acute kidney disease, obstructive sleep apnoea, family history of kidney disease, smoking, diabetes, peptic ulcer disease, hypertension and hyperlipidemia were commonly found to be associated with CKD. A binary logistic regression model was carried out to assess the risk factors for CKD. Sex, history of acute kidney disease, family history of kidney disease, obstructive sleep apnoea, smoking status, peptic ulcer, diabetes, hypertension, hyperlipidemia, hypertension and diabetes, two or more comorbidities and NSAID use had an increased risk of CKD. Conclusion Sex, history of acute kidney disease, obstructive sleep apnoea, family history, smoking, diabetes, hypertension, peptic ulcer, hyperlipidemia, multi-comorbidity, and use of NSAIDs are all associated with an increased risk of CKD. The prevalence of CKD in this study is comparatively lower when compared to other regions in Saudi Arabia.
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Chan KW, Smeijer JD, Schechter M, Jongs N, Vart P, Kohan DE, Gansevoort RT, Liew A, Tang SCW, Wanner C, de Zeeuw D, Heerspink HJL. Post hoc analysis of the SONAR trial indicates that the endothelin receptor antagonist atrasentan is associated with less pain in patients with type 2 diabetes and chronic kidney disease. Kidney Int 2023; 104:1219-1226. [PMID: 37657768 DOI: 10.1016/j.kint.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
Pain is prevalent among patients with diabetes and chronic kidney disease (CKD). The management of chronic pain in these patients is limited by nephrotoxicity of commonly used drugs including non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Since previous studies implicated endothelin-1 in pain nociception, our post hoc analysis of the SONAR trial assessed the association between the endothelin receptor antagonist atrasentan and pain and prescription of analgesics. SONAR was a randomized, double-blind, placebo-controlled clinical trial that recruited participants with type 2 diabetes and CKD (estimated glomerular filtration rate 25-75 ml/min/1.73 m2; urinary albumin-to-creatinine ratio 300-5000 mg/g). Participants were randomized to receive atrasentan or placebo (1834 each arm). The main outcome was pain-related adverse events (AEs) reported by investigators. We applied Cox regression to assess the effect of atrasentan compared to placebo on the risk of the first reported pain-related AE and, secondly, first prescription of analgesics. We used the Anderson-Gill method to assess effects on all (first and subsequent) pain-related AEs. During 2.2-year median follow-up, 1183 pain-related AEs occurred. Rates for the first pain-related event were 138.2 and 170.2 per 1000 person-years in the atrasentan and placebo group respectively (hazard ratio 0.82 [95% confidence interval 0.72-0.93]). Atrasentan also reduced the rate of all (first and subsequent) pain-related AEs (rate ratio 0.80 [0.70-0.91]). These findings were similar after accounting for competing risk of death (sub-hazard ratio 0.81 [0.71-0.92]). Patients treated with atrasentan initiated fewer analgesics including NSAIDs and opioids compared to placebo during follow-up (hazard ratio = 0.72 [0.60-0.88]). Thus, atrasentan was associated with reduced pain-related events and pain-related use of analgesics in carefully selected patients with type 2 diabetes and CKD.
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Affiliation(s)
- Kam Wa Chan
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR; School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR
| | - J David Smeijer
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Meir Schechter
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Donald E Kohan
- Division of Nephrology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ron T Gansevoort
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, Würzburg University Clinic, Würzburg, Germany; Department of Clinical Research and Epidemiology, Renal Research Unit, Comprehensive Heart Failure Center, Würzburg University, Würzburg, Germany
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; The George Institute for Global Health, Sydney, New South Wales, Australia.
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Krichbaum M, Miransky N, Perez A. Trends in Pain Medication Use in Patients With Type 2 Diabetes: NHANES 2005-2018. J Pain Palliat Care Pharmacother 2023; 37:223-233. [PMID: 37039630 DOI: 10.1080/15360288.2023.2194868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
The aim of this research was to compare pain medication use trends among adults with and without type 2 diabetes in the US. This cross-sectional study used data of adults with and without (type 2) diabetes from the National Health and Nutrition Examination Survey waves 2005-2018. Use of pain medication including opioids, prescription nonsteroidal anti-inflammatory drugs, gabapentinoids, serotonin norepinephrine reuptake inhibitors, skeletal muscle relaxants, and headache treatment agents was compared by diabetes status and within select social determinants of health and clinical factors. Adults with type 2 diabetes were twice as likely to be prescribed pain medications compared to those without a diabetes diagnosis (16.2% vs 8.6%). Females and those with a history of smoking or arthritis were more likely to be on pain medications. Opioid use was the most prevalent regardless of diabetes status, and use was twice as high among those with diabetes (10.8% vs 5.5%). Patients with type 2 diabetes in the US are twice as likely to be prescribed pain medications overall as well as opioids compared with those without diabetes. Clinical guideline recommendations are necessary to find pharmacologic and nonpharmacologic nociceptive pain management specific for patients with diabetes.
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Reding MT, Pabinger I, Holme PA, Maas Enriquez M, Mancuso ME, Lalezari S, Miesbach W, Di Minno G, Klamroth R, Hermans C. Efficacy and safety of damoctocog alfa pegol prophylaxis in patients ⩾40 years with severe haemophilia A and comorbidities: post hoc analysis from the PROTECT VIII study. Ther Adv Hematol 2023; 14:20406207231166779. [PMID: 37113811 PMCID: PMC10126693 DOI: 10.1177/20406207231166779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Background Advances in treatment have enabled patients with haemophilia A to live longer and therefore may be subjected to comorbidities associated with ageing, in addition to disease-associated morbidities. There have been few reports to date on efficacy and safety of treatment specifically in patients with severe haemophilia A and comorbidities. Objective To explore the efficacy and safety of damoctocog alfa pegol prophylaxis in patients with severe haemophilia A aged ⩾40 years with comorbidities of interest. Design A post hoc analysis of data from the phase 2/3 PROTECT VIII study and its extension. Methods Bleeding and safety outcomes were analysed in a subgroup of patients aged ⩾40 years with ⩾1 comorbidity receiving damoctocog alfa pegol (BAY 94-9027; Jivi®) prophylaxis. Results Thirty-four patients with severe haemophilia A were included in this analysis, with a mean age of 49.4 years at time of enrolment. The most prevalent comorbidities were hepatitis C (n = 33; chronic, n = 23), hepatitis B (n = 8) and hypertension (n = 11). Four patients had human immunodeficiency virus. All received damoctocog alfa pegol prophylaxis for the entire study [median (range) time in study = 3.9 (1.0-6.9) years]. During the main study and extension, median total annualised bleeding rates (ABRs) (Q1; Q3) were 2.1 (0.0; 5.8) and 2.2 (0.6; 6.0), respectively; median joint ABRs were 1.9 (0.0; 4.4) and 1.6 (0.0; 4.0), respectively. Mean adherence with prophylaxis schedule was greater than 95% throughout the study. No deaths or thrombotic events were reported. Conclusion Efficacy, safety and adherence of damoctocog alfa pegol were confirmed in patients aged ⩾40 years with haemophilia A and one or more comorbidities, with data for up to 7 years supporting its use as a long-term treatment option in this group. Plain language summary Advances in treatment mean that people with haemophilia A are now living longer and, as a result, may have additional medical conditions that occur with ageing. We aimed to investigate the efficacy and safety of the long-acting replacement factor VIII damoctocog alfa pegol in people with severe haemophilia A who had additional medical conditions. To do this, we investigated the recorded information about patients aged 40 years of age or older who had been treated with damoctocog alfa pegol in a previously completed clinical trial. We found that the treatment was well-tolerated; no deaths or thrombotic events (undesirable clotting events) were reported. Treatment was efficacious in reducing bleeding in this group of patients. The findings support the use of damoctocog alfa pegol as a long-term treatment for older patients with haemophilia A and coexisting conditions.
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Affiliation(s)
| | - Ingrid Pabinger
- University Clinic for Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Pål Andrè Holme
- Department of Haematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Milan, Italy; Humanitas University, Milan, Italy
| | - Shadan Lalezari
- National Haemophilia Centre, Chaim Sheba Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | | | - Giovanni Di Minno
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy
| | | | - Cedric Hermans
- Division of Haematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Louvain, Belgium
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Zhang XY, He QS, Jing Z, He JX, Yuan JQ, Dai XY. Effect of proton pump inhibitors on the risk of chronic kidney disease: A propensity score-based overlap weight analysis using the United Kingdom Biobank. Front Pharmacol 2022; 13:949699. [PMID: 36438798 PMCID: PMC9685407 DOI: 10.3389/fphar.2022.949699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/25/2022] [Indexed: 02/07/2024] Open
Abstract
Background: Proton pump inhibitors (PPIs) are widely used and have been linked to kidney diseases. However, the role of PPI use in the development of chronic kidney disease (CKD) remains unclear. We undertook this study to examine the association between PPI use and the subsequent risk of CKD. Methods: This is a prospective analysis of 462,421 participants free of cancer diagnosis or chronic kidney disease from the United Kingdom Biobank. Self-reported PPI use was recorded using an electronic questionnaire and confirmed by a trained staff. Incident CKD was identified based on the medical history. Overlap propensity score weighting with the Cox model was used to calculate the effect of PPI use on CKD risk. The number needed to harm (NNH) was calculated at 5 and 10 years of follow-up. Results: We documented 7,031 cases of CKD over a median follow-up of 8.1 years. Overlap propensity score weighting analysis showed that regular PPI users had a 37% higher risk of CKD incident than non-users (HR 1.37, 95% CI 1.28-1.47). The association persisted across subgroup analyses, different types of PPIs, and several sensitivity analyses. Quantitative bias analysis indicated that the result was robust to unmeasured confounding (E-value 2.08, lower 95% CI 1.88). The NNH was 147.9 and 78.6 for 5 and 10 years of follow-up, respectively. A head-to-head comparison showed that PPI users had a 19% higher risk of CKD than H2RA users (HR 1.19, 95% CI 1.02-1.39). Conclusion: The regular use of PPI is associated with a higher risk of CKD. Healthcare providers should carefully weigh up the potential benefits against the risk in prescribing PPIs, particularly for patients requiring long-term treatment.
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Affiliation(s)
- Xing-Yu Zhang
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Qiang-Sheng He
- Clinical Research Center, Guangdong; Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhong Jing
- Department of Nephrology, Mianyang 404 Hospital, Mianyang, China
| | - Juan-Xia He
- Department of Information Engineering, University of Lanzhou City, Lanzhou, China
| | - Jin-Qiu Yuan
- Clinical Research Center, Guangdong; Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiao-Yu Dai
- Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
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Tofteng SS, Nilsson L, Mogensen AK, Nørregaard R, Nüsing R, Diatchikhine M, Lund L, Bistrup C, Jensen BL, Madsen K. Increased COX-2 after ureter obstruction attenuates fibrosis and is associated with EP 2 receptor upregulation in mouse and human kidney. Acta Physiol (Oxf) 2022; 235:e13828. [PMID: 35543087 PMCID: PMC9542224 DOI: 10.1111/apha.13828] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 12/20/2022]
Abstract
AIM Cyclooxygenase-2 (COX-2) activity protects against oxidative stress and apoptosis early in experimental kidney injury. The present study was designed to test the hypothesis that COX-2 activity attenuates fibrosis and preserves microvasculature in injured kidney. The murine unilateral ureteral-obstruction (UUO) model of kidney fibrosis was employed and compared with human nephrectomy tissue with and without chronic hydronephrosis. METHODS Fibrosis and angiogenic markers were quantified in kidney tissue from wild-type and COX-2-/- mice subjected to UUO for 7 days and in human kidney tissue. COX-enzymes, prostaglandin (PG) synthases, PG receptors, PGE2 , and thromboxane were determined in human tissue. RESULTS COX-2 immunosignal was observed in interstitial fibroblasts at baseline and after UUO. Fibronectin, collagen I, III, alpha-smooth muscle actin, and fibroblast specific protein-1 mRNAs increased significantly more after UUO in COX-2-/- vs wild-type mice. In vitro, fibroblasts from COX-2-/- kidneys showed higher matrix synthesis. Compared to control, human hydronephrotic kidneys showed (i) fibrosis, (ii) no significant changes in COX-2, COX-1, PGE2 -, and prostacyclin synthases, and prostacyclin and thromboxane receptor mRNAs, (iii) increased mRNA and protein of PGE2 -EP2 receptor level but unchanged PGE2 tissue concentration, and (iv) two- to threefold increased thromboxane synthase mRNA and protein levels, and increased thromboxane B2 tissue concentration in cortex and outer medulla. CONCLUSION COX-2 protects in the early phase against obstruction-induced fibrosis and maintains angiogenic factors. Increased PGE2 -EP2 receptor in obstructed human and murine kidneys could contribute to protection.
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Affiliation(s)
- Signe S. Tofteng
- Department of Cardiovascular and Renal Research, Institute of Molecular MedicineUniversity of Southern DenmarkOdenseDenmark
| | - Line Nilsson
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Amalie K. Mogensen
- Department of Cardiovascular and Renal Research, Institute of Molecular MedicineUniversity of Southern DenmarkOdenseDenmark
| | | | - Rolf Nüsing
- Institute of Clinical PharmacologyGoethe UniversityFrankfurtGermany
| | | | - Lars Lund
- Department of UrologyOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Claus Bistrup
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Department of NephrologyOdense University HospitalOdenseDenmark
| | - Boye L. Jensen
- Department of Cardiovascular and Renal Research, Institute of Molecular MedicineUniversity of Southern DenmarkOdenseDenmark
| | - Kirsten Madsen
- Department of Cardiovascular and Renal Research, Institute of Molecular MedicineUniversity of Southern DenmarkOdenseDenmark,Department of PathologyOdense University HospitalOdenseDenmark
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Klomjit N, Ungprasert P. Acute kidney injury associated with non-steroidal anti-inflammatory drugs. Eur J Intern Med 2022; 101:21-28. [PMID: 35534373 DOI: 10.1016/j.ejim.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 12/27/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are ones of the commonly prescribed drugs worldwide. They primarily inhibit cyclooxygenase (COX) enzyme which is responsible for conversion of phospholipids to various prostaglandins (PGs). Disruption in PGs production affects the kidneys in several ways, including vasoconstriction that may result in ischemic acute kidney injury (AKI) in at-risk patients. They also impair salt and water excretion, leading to edema and hypertension. Other complications include hyperkalemia, hyponatremia, nephrotic syndrome, acute interstitial nephritis and chronic kidney disease progression. AKI from NSAIDs is usually reversible with favorable prognosis after discontinuation of NSAIDs. Avoidance of NSAIDs exposure is extremely important, especially among high-risk patients.
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Affiliation(s)
- Nattawat Klomjit
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, USA.
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
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Yeater TD, Cruz CJ, Cruz-Almeida Y, Allen KD. Autonomic Nervous System Dysregulation and Osteoarthritis Pain: Mechanisms, Measurement, and Future Outlook. Curr Rheumatol Rep 2022; 24:175-183. [PMID: 35420372 PMCID: PMC9189055 DOI: 10.1007/s11926-022-01071-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW The autonomic nervous system is an important regulator of stress responses and exhibits functional changes in chronic pain states. This review discusses potential overlap among autonomic dysregulation, osteoarthritis (OA) progression, and chronic pain. From this foundation, we then discuss preclinical to clinical research opportunities to close gaps in our knowledge of autonomic dysregulation and OA. Finally, we consider the potential to generate new therapies for OA pain via modulation of the autonomic nervous system. RECENT FINDINGS Recent reviews provide a framework for the autonomic nervous system in OA progression; however, research is still limited on the topic. In other chronic pain states, functional overlaps between the central autonomic network and pain processing centers in the brain suggest relationships between concomitant dysregulation of the two systems. Non-pharmacological therapeutics, such as vagus nerve stimulation, mindfulness-based meditation, and exercise, have shown promise in alleviating painful symptoms of joint diseases, and these interventions may be partially mediated through the autonomic nervous system. The autonomic nervous system appears to be dysregulated in OA progression, and further research on rebalancing autonomic function may lead to novel therapeutic strategies for treating OA pain.
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Affiliation(s)
- Taylor D. Yeater
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Carlos J. Cruz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL, USA.,Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Kyle D. Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Yang X, Zhou B, Zhou L, Cui L, Zeng J, Wang S, Shi W, Zhang Y, Luo X, Xu C, Xue Y, Chen H, Chen S, Wang G, Guo L, Jose PA, Wilcox CS, Wu S, Wu G, Zeng C. Development and Validation of Prediction Models for Hypertensive Nephropathy, the PANDORA Study. Front Cardiovasc Med 2022; 9:794768. [PMID: 35360013 PMCID: PMC8960139 DOI: 10.3389/fcvm.2022.794768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
ImportanceHypertension is a leading cause of end-stage renal disease (ESRD), but currently, those at risk are poorly identified.ObjectiveTo develop and validate a prediction model for the development of hypertensive nephropathy (HN).Design, Setting, and ParticipantsIndividual data of cohorts of hypertensive patients from Kailuan, China served to derive and validate a multivariable prediction model of HN from 12, 656 individuals enrolled from January 2006 to August 2007, with a median follow-up of 6.5 years. The developed model was subsequently tested in both derivation and external validation cohorts.VariablesDemographics, physical examination, laboratory, and comorbidity variables.Main Outcomes and MeasuresHypertensive nephropathy was defined as hypertension with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or proteinuria.ResultsAbout 8.5% of patients in the derivation cohort developed HN after a median follow-up of 6.5 years that was similar in the validation cohort. Eight variables in the derivation cohort were found to contribute to the risk of HN: salt intake, diabetes mellitus, stroke, serum low-density lipoprotein, pulse pressure, age, hypertension duration, and serum uric acid. The discrimination by concordance statistics (C-statistics) was 0.785 (IQR, 0.770-0.800); the calibration slope was 1.129, the intercept was –0.117; and the overall accuracy by adjusted R2 was 0.998 with similar results in the validation cohort. A simple points scale developed from these data (0, low to 40, high) detected a low morbidity of 7% in the low-risk group (0–10 points) compared with >40% in the high-risk group (>20 points).Conclusions and RelevanceA prediction model of HN over 8 years had high discrimination and calibration, but this model requires prospective evaluation in other cohorts, to confirm its potential to improve patient care.
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Affiliation(s)
- Xiaoli Yang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Bingqing Zhou
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Li Zhou
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Liufu Cui
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jing Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Shuo Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Weibin Shi
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Ye Zhang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Xiaoli Luo
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Chunmei Xu
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Yuanzheng Xue
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Hao Chen
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Li Guo
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pedro A. Jose
- Division of Renal Disease & Hypertension, The George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Christopher S. Wilcox
- Division of Nephrology and Hypertension, Department of Medicine and Center for Hypertension, Kidney and Vascular Health, Georgetown University, Washington, DC, United States
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
- *Correspondence: Shouling Wu,
| | - Gengze Wu
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
- Gengze Wu,
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, The Third Military Medical University, Chongqing, China
- Cardiovascular Research Center of Chongqing College, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Chongqing, China
- Chunyu Zeng,
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10
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Viticchi G, Falsetti L, Salvemini S, Bartolini M, Ranghino A, Buratti L, Silvestrini M. Headache changes after kidney transplant. Acta Neurol Belg 2022; 122:83-90. [PMID: 33687728 DOI: 10.1007/s13760-021-01637-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Headache is considered as a possible complication of dialytic treatment in chronic kidney disease (CKD). The aim of this study was to evaluate possible change in headache characteristics after kidney transplantation in patients with CKD. During a 1-year period, we enrolled 110 subjects submitted to a kidney transplant in the previous 5 years. Headache characteristics before and after the transplant were investigated by a specific questionnaire. Possible effects of pharmacological therapies were also evaluated. 65.5% of patients complained of headache before the transplant (38.2% migraine and 14.5% dialysis headache). After transplant, 53.6% of patients reported changes in headache characteristics. In particular, 27.3% of the patients had a complete resolution, 19.1% presented a headache improvement and 7.2% showed a worsening. In both migraine and dialysis headache subgroups, steroids, beta-blockers and calcium channel blockers were associated with a significant improvement of headache. Kidney transplantation seems to impact significantly headache frequency and severity in patients with CKD. A careful evaluation and use of targeted treatments could improve both patients' compliance to therapies and quality of life.
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Affiliation(s)
- Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, Via Conca 1, 60020, Ancona, Italy.
| | - Lorenzo Falsetti
- Internal and Subintesive Medicine, Ospedali Riuniti Ancona, Ancona, Italy
| | - Sergio Salvemini
- Neurological Clinic, Marche Polytechnic University, Via Conca 1, 60020, Ancona, Italy
| | - Marco Bartolini
- Neurological Clinic, Marche Polytechnic University, Via Conca 1, 60020, Ancona, Italy
| | - Andrea Ranghino
- Nephrology, Dialysis and Kidney Transplant Unit, Ospedali Riuniti Ancona, Ancona, Italy
| | - Laura Buratti
- Neurological Clinic, Marche Polytechnic University, Via Conca 1, 60020, Ancona, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, Via Conca 1, 60020, Ancona, Italy
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11
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Jerosch J. [Conservative treatment options for arthritis of the ankle : What is possible, what is effective?]. Unfallchirurg 2022; 125:175-182. [PMID: 35041020 DOI: 10.1007/s00113-021-01122-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
In this article the causes of arthritis in the region of the ankle are introduced and the conservative treatment options are described and discussed more extensively. The risks of treatment with nonopioid analgesics (NOPA) are presented in detail. The topical use of nonsteroidal anti-inflammatory drugs (NSAID) should always be considered in the clinical routine. If contraindications for oral NSAIDs are present, intra-articular treatment is a meaningful option. The best evidence is currently available for viscosupplementation but the study situation for the use of platelet-rich plasma (PRP) is still not sufficiently comprehensive and there are only a few case reports on the use of mesenchymal stem cells..
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Affiliation(s)
- Jörg Jerosch
- Medizinisches Wissenschafts- und Gutachten-Institut Meerbusch (WGI) Meerbusch, Grabenstr. 11, 40667, Meerbusch, Deutschland.
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12
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Steinmetz-Späh J, Arefin S, Larsson K, Jahan J, Mudrovcic N, Wennberg L, Stenvinkel P, Korotkova M, Kublickiene K, Jakobsson PJ. Effects of microsomal prostaglandin E synthase-1 (mPGES-1) inhibition on resistance artery tone in patients with end stage kidney disease. Br J Pharmacol 2021; 179:1433-1449. [PMID: 34766335 DOI: 10.1111/bph.15729] [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: 04/16/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Inhibition of the microsomal prostaglandin (PG) E2 synthase (mPGES-1) introduces a promising anti-inflammatory treatment approach by specifically reducing PGE2 . The microvasculature is a central target organ for early manifestations of cardiovascular disease. Therefore, a better understanding of the prostaglandin system and characterising the effects of mPGES-1 inhibition in this vascular bed are of interest. EXPERIMENTAL APPROACH The effects of mPGES-1 inhibition on constriction and relaxation of resistance arteries (Ø100-400μm) from patients with end stage kidney disease (ESKD) and controls (Non-ESKD) were studied using wire-myography in combination with immunological and mass-spectrometry based analyses. KEY RESULTS Inhibition of mPGES-1 in arteries from ESKD patients and Non-ESKD controls significantly reduced adrenergic vasoconstriction, which was not affected by the COX-2 inhibitors NS-398 and Etoricoxib or the COX-1/COX-2 inhibitor Indomethacin, tested in Non-ESKD controls. Correspondingly, a significant increase of acetylcholine-induced dilatation was observed for mPGES-1 inhibition only. In IL-1β treated arteries, inhibition of mPGES-1 significantly reduced PGE2 levels while PGI2 levels remained unchanged. In contrast, COX-2 inhibition blocked the formation of both prostaglandins. Blockage of PGI2 signaling with an IP receptor antagonist did not restore the reduced constriction, neither did blocking of PGE2 -EP4 or signaling through PPARγ. A biphasic effect was observed for PGE2 , inducing dilatation at nmol and constriction at μmol concentrations. Immunohistochemistry demonstrated expression of mPGES-1, COX-1, PGIS, weak expression for COX-2 as well as receptor expression for PGE2 (EP1-4), thromboxane (TP) and PGI2 (IP) in ESKD and Non-ESKD. CONCLUSION Our study demonstrates vasodilating effects following mPGES-1 inhibition in human microvasculature and suggests that several pathways besides shunting to PGI2 may be involved.
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Affiliation(s)
- Julia Steinmetz-Späh
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Samsul Arefin
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Karin Larsson
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Jabin Jahan
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Neja Mudrovcic
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Lars Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Marina Korotkova
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
| | - Per-Johan Jakobsson
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
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13
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Bruno AS, Lopes PDD, de Oliveira KCM, de Oliveira AK, de Assis Cau SB. Vascular Inflammation in Hypertension: Targeting Lipid Mediators Unbalance and Nitrosative Stress. Curr Hypertens Rev 2021; 17:35-46. [PMID: 31858899 DOI: 10.2174/1573402116666191220122332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022]
Abstract
Arterial hypertension is a worldwide public health threat. High Blood Pressure (BP) is commonly associated with endothelial dysfunction, nitric oxide synthases (NOS) unbalance and high peripheral vascular resistance. In addition to those, inflammation has also been designated as one of the major components of BP increase and organ damage in hypertension. This minireview discusses vascular inflammatory triggers of high BP and aims to fill the existing gaps of antiinflammatory therapy of hypertension. Among the reasons discussed, enhanced prostaglandins rather than resolvins lipid mediators, immune cell infiltration and oxidative/nitrosative stress are pivotal players of BP increase within the inflammatory hypothesis. To address these inflammatory targets, this review also proposes new concepts in hypertension treatment with non-steroidal antiinflammatory drugs (NSAIDs), nitric oxide-releasing NSAIDs (NO-NSAIDs) and specialized proresolving mediators (SPM). In this context, the failure of NSAIDs in hypertension treatment seems to be associated with the reduction of endogenous NO bioavailability, which is not necessarily an effect of all drug members of this pharmacological class. For this reason, NO-releasing NSAIDs seem to be safer and more specific therapy to treat vascular inflammation in hypertension than regular NSAIDs.
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Affiliation(s)
- Alexandre S Bruno
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Patricia das Dores Lopes
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Karla C M de Oliveira
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Anizia K de Oliveira
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Stefany B de Assis Cau
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
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14
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Wan EYF, Yu EYT, Chan L, Mok AHY, Wang Y, Chan EWY, Wong ICK, Lam CLK. Comparative Risks of Nonsteroidal Anti-Inflammatory Drugs on CKD. Clin J Am Soc Nephrol 2021; 16:898-907. [PMID: 33910887 PMCID: PMC8216605 DOI: 10.2215/cjn.18501120] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES There have been doubts about the association between nonsteroidal anti-inflammatory drug use and worsening kidney function, and whether there is a difference between risks of individual nonsteroidal anti-inflammatory drugs is presently unclear. Therefore, this study aimed to evaluate the association between nonsteroidal anti-inflammatory drug exposure and the risk of incident eGFR <60 ml/min per 1.73 m2 and compare the risks between nonsteroidal anti-inflammatory drug subtypes in the Chinese population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS From 2008 to 2017, a total of 1,982,488 subjects aged 18 years or older with baseline eGFR ≥60 ml/min per 1.73 m2 were enrolled in this retrospective cohort study. Multivariable Cox proportional hazards regression adjusted for each patient's baseline characteristics was adopted to examine the association between nonsteroidal anti-inflammatory drug and incident eGFR <60 ml/min per 1.73 m2 or eGFR decline ≥30% with reference to baseline. RESULTS After a median follow-up duration of 6.3 (interquartile range, 3.3-9.4) years, 271,848 cases (14%) of incident eGFR <60 ml/min per 1.73 m2 and 388,386 (21%) events of eGFR decline ≥30% were recorded. After adjusting for each patient's baseline characteristics, nonsteroidal anti-inflammatory drug treatment was shown to be associated with a significantly higher risk of incident eGFR <60 ml/min per 1.73 m2 (hazard ratio, 1.71; 95% confidence interval, 1.67 to 1.75) and eGFR decline ≥30% (hazard ratio, 1.93; 95% confidence interval, 1.89 to 1.96) when compared with no nonsteroidal anti-inflammatory drug, with etoricoxib exhibiting the highest risk of eGFR<60 ml/min per 1.73 m2 (hazard ratio, 3.12; 95% confidence interval, 2.69 to 3.62) and eGFR decline ≥30% (hazard ratio, 3.11; 95% confidence interval, 2.78 to 3.48) and ibuprofen displaying the lowest risk of eGFR<60 ml/min per 1.73 m2 (hazard ratio, 1.12; 95% confidence interval, 1.02 to 1.23) and eGFR decline ≥30% (hazard ratio, 1.32; 95% confidence interval, 1.23 to 1.41). CONCLUSIONS Nonsteroidal anti-inflammatory drug exposure was associated with higher risks of incident eGFR <60 ml/min per 1.73 m2 and eGFR decline ≥30%. Highest risk was observed in etoricoxib users, and lowest risk was with ibuprofen. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_04_28_CJN18501120.mp3.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Linda Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Anna Hoi Ying Mok
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Yuan Wang
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong,Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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15
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Guthrie B. Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: CON. KIDNEY360 2020; 1:1189-1191. [PMID: 35372868 DOI: 10.34067/kid.0005112020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
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16
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Yang FC, Wang SS, Chen HM, Chen CH, Pong SC, Chen CM. Adaptation Process of Male Kidney Transplant Recipients During the Difficult Postoperative Recovery Stage at Home. Transplant Proc 2020; 52:3221-3225. [PMID: 32694059 DOI: 10.1016/j.transproceed.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Kidney transplantation is the main treatment for irreversible organ failure. It helps patients regain hope, prolongs their lives, and improves their quality of life. Because of cultural barriers, male kidney-transplant recipients in Taiwan may face a difficult adaptation process during postoperative care at home. METHODS In this qualitative exploratory study, we employed purposive sampling of male kidney-transplant recipients that was obtained from a leading medical center in Taiwan. Semi-structured, face-to-face interviews were used to collect data, which were further content analyzed. RESULTS All 30 qualified patients were approached and agreed to participate (age range = 29-67 years). Participants' post-kidney transplant time frame ranged from 2 to 22 years. We revealed several difficulties that participants experienced during their postoperative recovery: (1) physical and mental exhaustion and treatment side effects; (2) worry and uncertainty about rejection, graft failure, and the future; (3) fear of losing one's job and putting the family in financial trouble; and (4) impaired self-image and social barriers. Corresponding adaptation processes included (1) experiencing shock during the early post-transplantation stage, (2) re-identification of the transition period of self-value, (3) seeking support and thinking positively, (4) accepting one's new self-image, and (5) regaining autonomy. CONCLUSION The current results can be used to improve the quality of care at home for male kidney-transplant recipients. Health care providers should assist patients in the adaptation process to reduce discomfort and relieve stress. This study can also serve as a reference for future research.
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Affiliation(s)
- Fu-Chi Yang
- College of General Education, National Chin-Yi University of Technology, Taichung, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shoei-Shen Wang
- Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, Fu Jen Catholic University Hospital, and School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
| | - Hsiao-Mei Chen
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Department of Medicine, Taichung Veterans General Hospital; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Su-Chen Pong
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Min Chen
- Department of Nursing, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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17
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Tomlin A, Woods DJ, Lambie A, Eskildsen L, Ng J, Tilyard M. Ethnic inequality in non-steroidal anti-inflammatory drug-associated harm in New Zealand: A national population-based cohort study. Pharmacoepidemiol Drug Saf 2020; 29:881-889. [PMID: 32476226 DOI: 10.1002/pds.5028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/07/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with many serious complications and they are widely used in New Zealand (NZ). However, differences in NSAID-associated risk for these complications between ethnic groups are largely unknown. We assessed ethnic disparities in risk of hospital admission for upper gastrointestinal bleeding (UGIB), heart failure, and acute kidney failure (AKF) in NZ's primary care population prescribed and dispensed NSAIDs. METHODS Retrospective cohort study utilising national pharmaceutical dispensing and hospital admissions data 2007 to 2015. Patient follow-up included 90-day periods following the dispensing of NSAIDs. Risk for each adverse outcome in Maori, Pacific, European, and Asian patients was estimated using multivariable Poisson regression adjusting for age, sex, deprivation, comorbidity and concurrent drug use. RESULTS 3 023 067 patients were dispensed NSAIDs between 2008 and 2015. Their total intended duration of NSAID treatment encompassed 2 353 140 patient-years. Maori, Pacific and Asian patients were younger than European patients (all P < .001). After adjusting for other risk factors, Maori (rate ratio: 2.54, 95% confidence interval: 2.23-2.90) and Pacific patients (3.17, 2.69-3.74) were more likely to be hospitalised for UGIB than Europeans (reference), and heart failure (Maori: 2.48, 2.24-2.74; Pacific: 1.97, 1.69-2.30). Risk of AKF was higher in Maori (1.46, 1.23-1.74). Higher risk for UGIB and HF in Maori and Pacific patients was most pronounced in males and patients aged <60 years. CONCLUSIONS Inequalities exist in the incidence of serious adverse outcomes experienced by different ethnic groups in NZ while using NSAIDs. Interventions to promote safer use of these medicines are required to reduce this inequity.
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Affiliation(s)
- Andrew Tomlin
- Best Practice Advocacy Centre NZ, Dunedin, New Zealand
| | - David John Woods
- Best Practice Advocacy Centre NZ, Dunedin, New Zealand.,New Zealand Pharmacovigilance Centre , University of Otago, Dunedin, New Zealand.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Angela Lambie
- Safety in Practice, Planning and Funding, Waitematā and Auckland District Health Boards, Auckland, New Zealand
| | - Lisa Eskildsen
- Safety in Practice, Planning and Funding, Waitematā and Auckland District Health Boards, Auckland, New Zealand
| | - Jerome Ng
- Safety in Practice, Planning and Funding, Waitematā and Auckland District Health Boards, Auckland, New Zealand
| | - Murray Tilyard
- Best Practice Advocacy Centre NZ, Dunedin, New Zealand.,Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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18
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Szeto CC, Sugano K, Wang JG, Fujimoto K, Whittle S, Modi GK, Chen CH, Park JB, Tam LS, Vareesangthip K, Tsoi KKF, Chan FKL. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations. Gut 2020; 69:617-629. [PMID: 31937550 DOI: 10.1136/gutjnl-2019-319300] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/06/2019] [Accepted: 12/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications, but they are associated with a number of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications. OBJECTIVE To develop a set of multidisciplinary recommendations for the safe prescription of NSAIDs. METHODS Randomised control trials and observational studies published before January 2018 were reviewed, with 329 papers included for the synthesis of evidence-based recommendations. RESULTS Whenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, blood pressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Blood pressure and renal function should be monitored in most cases. CONCLUSION NSAIDs are a valuable armamentarium in clinical medicine, but appropriate recognition of high-risk cases, selection of a specific agent, choice of ulcer prophylaxis and monitoring after therapy are necessary to minimise the risk of adverse events.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong.,Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong
| | - Kentaro Sugano
- Jichi Medical University, Shimotsuke, Tochigi, Japan.,Asian Pacific Association of Gastroenterology (APAGE), Tochigi, Japan
| | - Ji-Guang Wang
- Shanghai Institute of Hypertension, Shanghai, Shanghai, China.,Asia Pacific Society of Hypertension (APSH), Shanghai, China
| | - Kazuma Fujimoto
- Saga University, Saga, Japan.,Asia-Pacific Society for Digestive Endoscopy (APSDE), Saga, Japan
| | - Samuel Whittle
- The University of Adelaide, Adelaide, South Australia, Australia.,Asia Pacific League of Associations for Rheumatology (APLAR), Adelaide, South Australia, Australia
| | - Gopesh K Modi
- Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong.,Samarpan Kidney Institute and Research Center, Bhopal, India
| | - Chen-Huen Chen
- National Yang-Ming University, Taipei, Taiwan.,Pulse of Asia (PoA), Taipei, Taiwan
| | - Jeong-Bae Park
- Pulse of Asia (PoA), Taipei, Taiwan.,JB Lab and Clinic and Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong.,Asia Pacific League of Associations for Rheumatology (APLAR), Adelaide, South Australia, Australia
| | - Kriengsak Vareesangthip
- Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong.,Mahidol University, Nakorn Pathom, Thailand
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19
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Asfandiyarova NS, Philippov EV. [The use of nonsteroidal anti - inflammatory drugs in polymorbid pathology]. TERAPEVT ARKH 2020; 92:82-88. [PMID: 32598668 DOI: 10.26442/00403660.2020.01.000480] [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] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The literature review presents the possibilities of using non - steroidal anti - inflammatory drugs (NSAIDs) for polymorbid pathology. The mechanism of NSAIDs action, risk factors for the development of undesirable effects on the cardiovascular, digestive, urinary and other systems are considered; prevention measures and drug selection options are discussed, NSAIDs prescribing algorithm is considered.
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20
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Jerosch J. Konservative Therapie von Knorpelschäden am Sprunggelenk. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Migliore A, Gigliucci G, Alekseeva L, Avasthi S, Bannuru RR, Chevalier X, Conrozier T, Crimaldi S, Damjanov N, de Campos GC, Diracoglu D, Herrero-Beaumont G, Iolascon G, Ionescu R, Isailovic N, Jerosch J, Lains J, Maheu E, Makri S, Martusevich N, Matucci Cerinc M, Micu M, Pavelka K, Petrella RJ, Tarantino U, Raman R. Treat-to-target strategy for knee osteoarthritis. International technical expert panel consensus and good clinical practice statements. Ther Adv Musculoskelet Dis 2019; 11:1759720X19893800. [PMID: 31903099 PMCID: PMC6923692 DOI: 10.1177/1759720x19893800] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background: In this work, we aimed to establish a clinical target in the management of
knee osteoarthritis (KOA) and to propose good clinical practice (GCP)
statements for carrying out a treat-to-target strategy. Methods: A steering committee of seven experts had formulated a provisional set of
recommendations that were exposed for discussion and modification to a
technical expert panel (TEP) of 25 multidisciplinary experts from Europe,
North America, South America and Asia. The level of evidence and strength of
each recommendation was discussed. The TEP formulated overarching principles
and GCP statements based on the level of agreement for each item with a vote
using a 10-point numerical scale. Results: Two overarching principles and 10 GCP statements were formulated by the TEP.
These GCP statements suggest: treatment should achieve clinical improvement
bringing the patient to the Patient Acceptable Symptom State (PASS);
pharmacological and nonpharmacological treatment should begin as early as
possible, with an early diagnosis of symptomatic KOA; the patient should be
evaluated every 3–6 months; risk factors of KOA progression should be
identified and managed with patients at the beginning of the treatment and
monitored regularly; treatment should be adapted according to patient
phenotype and disease severity; healthy lifestyle must be promoted and
monitored. The level of agreement average ranged from 8.7 to 9.6 on
scale. Conclusions: The proposed overarching principles and GCP statements have the aim of
involving patients, general practitioners and multidisciplinary specialists
in sharing a therapeutic treat-to-target strategy for KOA management based
on the best evidence and expert opinions.
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Affiliation(s)
- Alberto Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | | | - Liudmila Alekseeva
- Department of Metabolic Diseases of Bone and Joints, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Sachin Avasthi
- Department of Emergency Medicine, Dr Ram Manohar Lohia Hospital, Lucknow, India
| | - Raveendhara R Bannuru
- Centre for Treatment Comparison and Integrative Analysis Division of Rheumatology, Tufts Medical Centre, Boston, MA, USA
| | | | | | - Sergio Crimaldi
- Chirurgia Ortopedica Mininvasiva e Nuove Tecnologie, Humanitas Research Hospital, Castellanza, Italy
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | | | - Demirhan Diracoglu
- Department of Physical Medicine and Rehabilitation Division of Pain Medicine, Istanbul University, Istanbul, Turkey
| | | | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania 'L Vanvitelli', Caserta, Italy
| | - Ruxandra Ionescu
- Department of Internal Medicine and Rheumatology Sf. Maria Hospital, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan 20089, Italy
| | - Jörg Jerosch
- Orthopaedic Department, Johanna Etienne Hospital, Neuss, Germany
| | - Jorge Lains
- Physical Rehabilitation Medicine Department, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Emmanuel Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Souzi Makri
- EUPATI Graduate and Patient Advocate, Brussels, Belgium
| | - Natalia Martusevich
- Department of Rheumatology, Belorussian State Medical University, Minsk, Belarus
| | - Marco Matucci Cerinc
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mihaela Micu
- Second Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | | | - Robert J Petrella
- Department of Family Medicine, School of Kinesiology University Western Ontario, Ontario, Canada
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, 'Policlinico Tor Vergata' Foundation, Rome, Italy
| | - Raghu Raman
- Academic Department of Orthopaedics, Hull and East Yorkshire NHS Trust Castle Hill Hospital, Cottingham, UK
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22
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Nakafero G, Grainge M, Valdes A, Townsend N, Mallen C, Zhang W, Doherty M, Mamas MA, Abhishek A. Do β-adrenoreceptor blocking drugs associate with reduced risk of symptomatic osteoarthritis and total joint replacement in the general population? A primary care-based, prospective cohort study using the Clinical Practice Research Datalink. BMJ Open 2019; 9:e032050. [PMID: 31375622 PMCID: PMC6688671 DOI: 10.1136/bmjopen-2019-032050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION To investigate if β-adrenoreceptor blocking drug (β-blocker) prescription reduces the risk of knee or hip osteoarthritis, total joint replacement and analgesic prescription. SETTING Primary care. METHODS AND ANALYSIS This is a cohort study using data from the Clinical Practice Research Datalink. Two separate analyses will be performed. Study 1 will be on the association between β-blocker prescription and incident knee/hip osteoarthritis. Inclusion criteria will be age ≥40 years. Exposed participants will be those with ≥2 continuous β-blocker prescriptions, and the index date will be the date of the first prescription of β-blocker. Unexposed participants will include up to four controls matched for age, sex, general practice surgery and propensity score for β-blocker prescription. Exclusion criteria will include contraindications to β-blockers, consultations for osteoarthritis or potent analgesic prescription before the index date. Outcomes will be knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain and hip pain. Study 2 will be on the association between β-blocker prescription and total joint replacement and analgesic prescription in people with osteoarthritis. Inclusion criteria will be age ≥40 years, knee or hip osteoarthritis, and index date will be as in study 1. Unexposed participants will be as in study 1, additionally matched for consultation for knee or hip osteoarthritis prior to the index date. Exclusion criteria will include contraindications to β-blockers and osteoarthritis in other joints prior to the index date. Outcomes will be total knee replacement (primary outcome), total hip replacement and new analgesic prescription. STATISTICAL ANALYSIS Kaplan-Meier curves will be plotted, and Cox proportional HRs and 95% CIs will be calculated. Stratified analysis will be performed by class of β-blocker, intrinsic sympathomimetic effect and indication(s) for prescription. ETHICS AND DISSEMINATION This study was ethically approved by the Independent Scientific Advisory Committee of the Medicines and Healthcare Authority (Ref 18_227R). The results of this study will be published in peer-reviewed journals and presented at conferences. SUMMARY This prospective cohort study will evaluate the analgesic potential of commonly used drugs for osteoarthritis pain.
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MESH Headings
- Adrenergic beta-Antagonists/administration & dosage
- Analgesics/administration & dosage
- Arthralgia/drug therapy
- Arthralgia/epidemiology
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Drug Therapy, Combination
- Humans
- Kaplan-Meier Estimate
- Osteoarthritis, Hip/drug therapy
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Primary Health Care
- Proportional Hazards Models
- Prospective Studies
- Research Design
- Risk Reduction Behavior
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Affiliation(s)
| | - Matthew Grainge
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Ana Valdes
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- Nottingham NIHR BRC, University of Nottingham, Nottingham, UK
| | | | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Weiya Zhang
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- Nottingham NIHR BRC, University of Nottingham, Nottingham, UK
| | - Mamas A Mamas
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, UK
- Nottingham NIHR BRC, University of Nottingham, Nottingham, UK
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23
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Predictors of gastrointestinal bleeding in older persons taking nonsteroidal anti-inflammatory drugs: Results from the FDA adverse events reporting system. J Am Assoc Nurse Pract 2019; 31:206-213. [PMID: 30589757 DOI: 10.1097/jxx.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Older adults continue to take nonsteroidal anti-inflammatory drugs (NSAIDs) to manage chronic pain. The study's purpose was to identify predictors of gastrointestinal (GI) bleeding in older adults taking NSAIDs. METHODS A secondary analysis of the 2016 Food and Drug Administration's Adverse Events Reporting System data was conducted with 1,347 cases aged 65 years and older with an NSAID as the primary suspect for an adverse drug event (ADE). Data included age, sex, NSAID, multiple NSAID use, rivaroxaban, warfarin, clopidogrel, cardiovascular drug (proxy for cardiovascular disease), diabetes drug (proxy for diabetes mellitus), and primary adverse drug response. CONCLUSIONS Aspirin was the primary suspect NSAID in 72.5% of cases. Rivaroxaban was taken in 67.9% of cases. Logistic regression was conducted to predict GI bleed versus other NSAID-related ADEs with age, sex, cardiovascular medication, diabetes medication, warfarin, clopidogrel, concurrent NSAID use, aspirin, and rivaroxaban as predictors. Aspirin, rivaroxaban, and concurrent NSAID were significant predictors of GI bleed. Gastrointestinal bleed risk versus other ADE risk increased by 39.77 times when taking aspirin, rivaroxaban, and another NSAIDs concurrently. IMPLICATIONS FOR PRACTICE Results support reduced NSAID use by older adults, especially aspirin, and avoidance of rivaroxaban in older persons taking NSAIDs.
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24
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Griffith LE, Gruneir A, Fisher K, Panjwani D, Gafni A, Patterson C, Markle-Reid M, Ploeg J. Insights on multimorbidity and associated health service use and costs from three population-based studies of older adults in Ontario with diabetes, dementia and stroke. BMC Health Serv Res 2019; 19:313. [PMID: 31096989 PMCID: PMC6524233 DOI: 10.1186/s12913-019-4149-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 05/08/2019] [Indexed: 01/03/2023] Open
Abstract
Background Most studies that examine comorbidity and its impact on health service utilization focus on a single index-condition and are published in disease-specific journals, which limit opportunities to identify patterns across conditions/disciplines. These comparisons are further complicated by the impact of using different study designs, multimorbidity definitions and data sources. The aim of this paper is to share insights on multimorbidity and associated health services use and costs by reflecting on the common patterns across 3 parallel studies in distinct disease cohorts (diabetes, dementia, and stroke) that used the same study design and were conducted in the same health jurisdiction over the same time period. Methods We present findings that lend to broader Insights regarding multimorbidity based on the relationship between comorbidity and health service use and costs seen across three distinct disease cohorts. These cohorts were originally created using multiple linked administrative databases to identify community-dwelling residents of Ontario, Canada with one of diabetes, dementia, or stroke in 2008 and each was followed for health service use and associated costs. Results We identified 376,434 indviduals wtih diabetes, 95,399 wtih dementia, and 29,671 with stroke. Four broad insights were identified from considering the similarity in comorbidity, utilization and cost patterns across the three cohorts: 1) the most prevalent comorbidity types were hypertension and arthritis, which accounted for over 75% of comorbidity in each cohort; 2) overall utilization increased consistently with the number of comorbidities, with the vast majority of services attributed to comorbidity rather than the index conditions; 3) the biggest driver of costs for those with lower levels of comorbidity was community-based care, e.g., home care, GP visits, but at higher levels of comorbidity the driver was acute care services; 4) service-specific comorbidity and age patterns were consistent across the three cohorts. Conclusions Despite the differences in population demographics and prevalence of the three index conditions, there are common patterns with respect to comorbidity, utilization, and costs. These common patterns may illustrate underlying needs of people with multimorbidity that are often obscured in literature that is still single disease-focused. Electronic supplementary material The online version of this article (10.1186/s12913-019-4149-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada.
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25G, Hamilton, Ontario, L8S 4K1, Canada
| | - Dilzayn Panjwani
- Women's College Research Institute, Women's College Hospital, 790 Bay St., 7th floor, Toronto, ON, M5G 1N8, Canada
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, Ontario, L8S 4K1, Canada
| | - Christopher Patterson
- Department of Medicine, McMaster University, St. Peter's Hospital, 88 Maplewood, Hamilton, Ontario, L8M 1W9, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25B, Hamilton, Ontario, L8S 4K1, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25C, Hamilton, Ontario, L8S 4K1, Canada
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25
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Hwang AY, Dave CV, Smith SM. Use of Prescription Medications That Potentially Interfere With Blood Pressure Control in New-Onset Hypertension and Treatment-Resistant Hypertension. Am J Hypertens 2018; 31:1324-1331. [PMID: 30052747 DOI: 10.1093/ajh/hpy118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/20/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Withdrawing medications that interfere with blood pressure (BP) is recommended in patients with uncontrolled BP, yet real-world use of such agents is not well characterized among individuals with hypertension. We aimed to evaluate the use of BP-interfering prescription medications among US patients with hypertension. METHODS This retrospective drug utilization study used medical and prescription claims (January 2008 to December 2014) in the MarketScan commercial claims database. We included adults, aged 18-65 years, with a hypertension diagnosis (International Classification of Diseases, Ninth Revision, code 401) and ≥1 antihypertensive medication fill. Two hypertension cohorts were examined-new antihypertensive drug users (incident hypertension) and patients requiring titration to a fourth antihypertensive (incident treatment-resistant hypertension [TRH]). Patient-level exposure to BP-interfering medications was assessed 6 months before and after the index date, defined as the first prescription fill of an antihypertensive drug or the first occurrence of overlapping use of ≥4 antihypertensive drugs. RESULTS We identified 521,028 patients with incident hypertension and 131,764 patients with incident TRH. The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones. Overall, 18.3% of the incident hypertension cohort and 17.6% of the incident TRH cohort initiated a BP-interfering medication following antihypertensive titration. Among patients previously taking a BP-interfering medication, 57.6% with incident hypertension and 64.9% with incident TRH refilled that medication after antihypertensive intensification. CONCLUSIONS The use of prescription BP-interfering medications, especially NSAIDs, is prevalent among patients requiring intensification of their antihypertensive regimen. Greater efforts to limit the use of these medications, where feasible, may be required among patients with uncontrolled hypertension.
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Affiliation(s)
- Andrew Y Hwang
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, North Carolina, USA
| | - Chintan V Dave
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Steven M Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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26
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Vijayan R, Afshan G, Bashir K, Cardosa M, Chadha M, Chaudakshetrin P, Hla KM, Joshi M, Javier FO, Kayani AG, Musba AT, Nimmaanrat S, Pantjawibowo D, Que JC, Vijayanand P. Tramadol: a valuable treatment for pain in Southeast Asian countries. J Pain Res 2018; 11:2567-2575. [PMID: 30425567 PMCID: PMC6205131 DOI: 10.2147/jpr.s162296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain. Methods To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic. Results Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain. Conclusions In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline.
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Affiliation(s)
- Ramani Vijayan
- Department of Anaesthesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia,
| | - Gauhar Afshan
- Department of Anaesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Khalid Bashir
- Department of Anaesthesia, Hameed Latif Hospital, Lahore, Pakistan
| | - Mary Cardosa
- Department of Anaesthesiology, Hospital Selayang, Selangor, Malaysia
| | - Madhur Chadha
- Department of Pain Medicine, Primus Hospital and Fortis Group of Hospitals, New Delhi, India
| | - Pongparadee Chaudakshetrin
- Pain Management Clinic, Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khin Myo Hla
- Department of Physical Medicine & Rehabilitation, Yangon General Hospital, University of Medicine-1, Yangon, Myanmar
| | - Muralidhar Joshi
- Department of Anaesthesia & Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Francis O Javier
- Pain Management Center, St Luke's Medical Center, Metro Manila, Philippines
| | - Asif Gul Kayani
- Department of Anesthesiology, Kulsum International Hospital, Islamabad, Pakistan
| | - Andi Takdir Musba
- Department of Anesthesiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Sasikaan Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Dwi Pantjawibowo
- Department of Anesthesiology, Intensive Therapy, and Hospital Pain Management, Premier Bintaro Hospital, South Tangerang, Indonesia
| | - Jocelyn C Que
- Center for Pain Medicine, Department of Anesthesiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
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27
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Kazmi I, Gullapudi L, Taal MW. What every doctor needs to know about chronic kidney disease. Br J Hosp Med (Lond) 2018; 79:438-443. [PMID: 30070954 DOI: 10.12968/hmed.2018.79.8.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic kidney disease is a global health problem that affects over 10% of adults worldwide. All doctors should have a basic knowledge of chronic kidney disease because it may complicate the management of many other medical conditions and is associated with numerous adverse outcomes. Chronic kidney disease should be regarded as a clinical syndrome rather than a specific diagnosis and attempts should always be made to identify the cause. Simple risk prediction tools have been developed to inform management decisions. Management is directed at slowing progression of chronic kidney disease and reducing the associated cardiovascular risk by treating hypertension, use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers as first-line therapy in high-risk cases, treatment with statins and lifestyle measures. Patients at high risk of rapid progression or requiring specific therapy as well as those with chronic kidney disease stage 4 or 5 should be referred to a nephrology service.
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Affiliation(s)
- Isma Kazmi
- Research Fellow and Specialist Registrar, Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby
| | - Latha Gullapudi
- Research Fellow and Specialist Registrar, Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby
| | - Maarten W Taal
- Professor of Medicine and Honorary Consultant Nephrologist, Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby and Department of Renal Medicine, Royal Derby Hospital, Derby DE22 3NE
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28
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DiNubile N. Glucosamine and Chondroitin Sulfate: What Has Been Learned Since the Glucosamine/chondroitin Arthritis Intervention Trial. Orthopedics 2018; 41:200-207. [PMID: 29771395 DOI: 10.3928/01477447-20180511-06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/13/2017] [Indexed: 02/03/2023]
Abstract
Glucosamine and chondroitin sulfate, alone or in combination, are used worldwide by individuals suffering from osteoarthritis pain. They are by prescription in some countries but are available as over-the-counter dietary supplements in other countries, such as the United States. The inconclusive results of the National Institutes of Health-sponsored Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) did little to clarify the efficacy of these agents. However, some newer studies have provided a better perspective on the potential benefits that they can offer. Because the 2 in combination showed a significant level of efficacy in the moderate-to-severe knee osteoarthritis subgroup of the GAIT, this review examines the randomized, controlled trials published from that time to the present. The findings of these studies are mixed, owing in some cases to the high rate of placebo response added to by the ethical incorporation of rescue analgesics into protocols designed to evaluate the slow-acting, subtle effects of glucosamine and chondroitin sulfate in combination. The strong influence of the placebo effect and confounding of results by rescue analgesics point to the importance of objective measurement tools such as osteoarthritis biomarker panels in long-term glucosamine/chondroitin sulfate clinical trials with less reliance on the subjective measurement tools commonly used in osteoarthritis trials of pharmaceuticals. [Orthopedics. 2018; 41(4):200-207.].
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29
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Tomlin AM, Reith DM, Woods DJ, Lloyd HS, Smith A, Fountain JS, Tilyard MW. A Pharmacoepidemiology Database System for Monitoring Risk Due to the Use of Medicines by New Zealand Primary Care Patients. Drug Saf 2018; 40:1259-1277. [PMID: 28766108 DOI: 10.1007/s40264-017-0579-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The use of large record-linked healthcare databases for drug safety research and surveillance is now accepted practice. New Zealand's standardized national healthcare datasets provide the potential to automate the conduct of pharmacoepidemiological studies to provide rapid validation of medicine safety signals. OBJECTIVES Our objectives were to describe the methodology undertaken by a semi-automated computer system developed to rapidly assess risk due to drug exposure in New Zealand's population of primary care patients and to compare results from three studies with previously published findings. METHODS Data from three national databases were linked at the patient level in the automated studies. A retrospective nested case-control design was used to evaluate risk for upper gastrointestinal bleeding (UGIB), acute kidney failure (AKF), and serious arrhythmia associated with individual medicines, therapeutic classes of medicines, and concurrent use of medicines from multiple therapeutic classes. RESULTS The patient cohort available for each study included 5,194,256 patients registered between 2007 and 2014, with a total of 34,630,673 patient-years at risk. An increased risk for UGIB was associated with non-steroidal anti-inflammatory drugs (NSAIDs) (adjusted odds ratio [AOR] 4.16, 95% confidence interval [CI] 3.90-4.43, p < 0.001) and selective serotonin reuptake inhibitors (AOR 1.39, 95% CI 1.20-1.62, p < 0.001); an increased risk for AKF was associated with NSAIDs (AOR 1.78, 95% CI 1.73-1.83, p < 0.001) and proton pump inhibitors (AOR 1.78, 95% CI 1.72-1.83, p < 0.001); and an increased risk for serious arrhythmia was associated with fluoroquinolones (AOR 1.38, 95% CI 1.26-151, p < 0.001) and penicillins (AOR 1.69, 95% CI 1.61-1.77, p < 0.001). CONCLUSIONS Automated case-control studies using New Zealand's healthcare datasets can replicate associations of risk with drug exposure consistent with previous findings. Their speed of conduct enables systematic monitoring of risk for adverse events associated with a wide range of medicines.
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Affiliation(s)
| | - David M Reith
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
| | - David J Woods
- Best Practice Advocacy Centre, Dunedin, 9016, New Zealand.,Dunedin School of Pharmacy, University of Otago, Dunedin, 9054, New Zealand
| | - Hywel S Lloyd
- Best Practice Advocacy Centre, Dunedin, 9016, New Zealand.,Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
| | - Alesha Smith
- Best Practice Advocacy Centre, Dunedin, 9016, New Zealand.,Dunedin School of Pharmacy, University of Otago, Dunedin, 9054, New Zealand
| | | | - Murray W Tilyard
- Best Practice Advocacy Centre, Dunedin, 9016, New Zealand.,Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
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30
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Wu CL, Chang CC, Kor CT, Yang TH, Chiu PF, Tarng DC, Hsu CC. Hydroxychloroquine Use and Risk of CKD in Patients with Rheumatoid Arthritis. Clin J Am Soc Nephrol 2018; 13:702-709. [PMID: 29661770 PMCID: PMC5969483 DOI: 10.2215/cjn.11781017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Hydroxychloroquine is widely used in patients with rheumatoid arthritis. However, large-scale studies examining the long-term effects of hydroxychloroquine on the development of kidney disease in patients with rheumatoid arthritis are lacking. We aimed to assess the long-term association of hydroxychloroquine use with the risk of developing CKD in this population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted an observational cohort study for patients with newly diagnosed rheumatoid arthritis who were enrolled prospectively in Taiwan's National Health Insurance Research Database between January 1, 2000 and December 31, 2013. We used multivariable Cox proportional hazard regression to analyze the association of hydroxychloroquine use with incident CKD. RESULTS A total of 2619 patients, including 1212 hydroxychloroquine users and 1407 hydroxychloroquine nonusers, were analyzed. Incident CKD was reported in 48 of 1212 hydroxychloroquine users and 121 of 1407 hydroxychloroquine nonusers. The incidence rate of CKD was lower in hydroxychloroquine users than in hydroxychloroquine nonusers (10.3 versus 13.8 per 1000 person-years). After multivariable adjustment, hydroxychloroquine users still had a lower risk of incident CKD (adjusted hazard ratio, 0.64; 95% confidence interval, 0.45 to 0.90; P=0.01) than hydroxychloroquine nonusers. The lower risk of subsequent CKD development was dose dependent and consistent across subgroup analyses. CONCLUSIONS Hydroxychloroquine use in patients with newly diagnosed rheumatoid arthritis is associated with a significantly lower risk of incident CKD compared with in nonusers.
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Affiliation(s)
- Chia-Lin Wu
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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31
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Hung SC, Liao KF, Hung HC, Lin CL, Lai SW, Lee PC, Hung SR. Using proton pump inhibitors correlates with an increased risk of chronic kidney disease: a nationwide database-derived case-controlled study. Fam Pract 2018; 35:166-171. [PMID: 29045621 DOI: 10.1093/fampra/cmx102] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Those taking proton pump inhibitors (PPIs) might have a higher risk of acute kidney injury. The long-term safety, especially the PPI-associated chronic kidney disease (CKD) is the subsequent concern. OBJECTIVE This study explores the potential relationship between using PPIs and CKD in Taiwan. METHODS Using a database collated by the Taiwan National Health Insurance programme, we conducted a population-based case-controlled study to identify 16 704 cases of patients aged 20 years or older with newly diagnosed CKD between 2000 and 2013. 16 704 controls were randomly selected and were matched by sex, age and comorbidities. 'Use' of PPIs was defined as when subjects had received at least a prescription for PPIs before the index date. 'Non-use' was defined as subjects who had never received a prescription for PPIs before the index date. The odds ratio (OR) for CKD associated with the use of PPIs was estimated by a logistic regression model. RESULTS The OR for CKD was 1.41 for subjects using PPIs [95% confidence interval (CI) 1.34, 1.48] compared with subjects who had never used PPIs. Almost all major types of PPIs present a weak association with increased odds of CKD in cumulative duration and dosage regression analysis. The OR in relation to cumulative duration (per month) of PPIs use was 1.02 (95% CI 1.01, 1.02) and the OR in relation to cumulative dosage (per microgram) of PPIs use was 1.23 (95% CI 1.18, 1.28). CONCLUSIONS Using PPIs presented 1.4-fold higher odds of CKD in Taiwan health insurance claims data analysis.
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Affiliation(s)
- Shih-Chang Hung
- Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chang Hung
- Department of Internal Medicine, Nantou Hospital, Nantou, Taiwan.,Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Po-Chang Lee
- Department of Surgery, Nantou Hospital, Nantou, Taiwan
| | - Shih-Rong Hung
- Department of Pharmacy, Erlin Christian Hospital, Changhua, Taiwan
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Dong YH, Chang CH, Wu LC, Hwang JS, Toh S. Comparative cardiovascular safety of nonsteroidal anti-inflammatory drugs in patients with hypertension: a population-based cohort study. Br J Clin Pharmacol 2018; 84:1045-1056. [PMID: 29468706 DOI: 10.1111/bcp.13537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 12/24/2022] Open
Abstract
AIMS Previous studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with higher cardiovascular risks. However, few have been active comparison studies that directly assessed the potential differential cardiovascular risk between NSAID classes or across individual NSAIDs. We compared the risk of major cardiovascular events between cyclooxygenase 2 (COX-2)-selective and nonselective NSAIDs in patients with hypertension. METHODS We conducted a cohort study of patients with hypertension who initiated COX-2-selective or nonselective NSAIDs in a population-based Taiwanese database. The outcomes included hospitalization for the following major cardiovascular events: ischaemic stroke, acute myocardial infarction, congestive heart failure, transient ischaemic attack, unstable angina or coronary revascularization. We followed patients for up to 4 weeks, based on the as-treated principle. We used inverse probability weighting to control for baseline and time-varying covariates, and estimated the on-treatment hazard ratios (HRs) and 95% conservative confidence interval (CIs). RESULTS We identified 2749 eligible COX-2-selective NSAID users and 52 880 eligible nonselective NSAID users. The HR of major cardiovascular events comparing COX-2-selective with nonselective NSAIDs after adjusting for baseline and time-varying covariates was 1.07 (95% CI 0.65, 1.74). We did not observe a differential risk when comparing celecoxib to diclofenac (HR 1.17; 95% CI 0.61, 2.25), ibuprofen (HR 1.36; 95% CI 0.58, 3.18) or naproxen (HR 0.75; 95% CI 0.23, 2.44). There was an increased risk with COX-2-selective NSAIDs, however, when comparing COX-2-selective NSAIDs with mefenamic acid (HR 2.11; 95% CI 1.09, 4.09). CONCLUSIONS Our results provide important information about the comparative cardiovascular safety of NSAIDs in patients with hypertension.
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Affiliation(s)
- Yaa-Hui Dong
- Faculty of Pharmacy, School of Pharmaceutical Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chia-Hsuin Chang
- Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Li-Chiu Wu
- Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, Taipei, 115, Taiwan
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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Shorog EM, Alburikan KA. The utilization of nonprescription medications in Saudi patients with cardiovascular diseases. Saudi Pharm J 2018; 26:120-124. [PMID: 29379343 PMCID: PMC5784444 DOI: 10.1016/j.jsps.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the most common cause of disease-related death in Saudi Arabia. The incidence of CVDs continues to increase, presenting a major health care problem. Nonprescription medications are widely used by patients with CVD and may cause adverse drug events, either by worsening the disease or by harmfully interacting with prescribed medications. We investigated the patterns of nonprescription medication utilization and the factors associated with their use in patients with CVD. METHODS This was a cross-sectional study conducted at the Cardiology Clinics of an academic tertiary health care center. Participants were asked about their sociodemographic characteristics, medical history and frequency of using nonprescription medications including over-the-counter (OTC) products, dietary supplements, and herbal products. Moreover, we investigated the participants' sources of information about nonprescription medications. Multivariate logistic regression analysis was conducted to examine the predictors of nonprescription medication use. RESULTS A total of 209 participants were interviewed. The mean age of the participants was 56 ± 15 years, and 110 (52.6%) were female. Of the 209 participants, 116 (55%) reported routine use of nonprescription medications. Black seeds and garlic were the most frequently used herbal products. Acetaminophen, cold/cough remedies, and ibuprofen were the most commonly reported OTC drugs. Of the surveyed patients, 54 (46.5%) used nonprescription medications to manage cardiovascular conditions specifically. Compared with other comorbidities, diabetes mellitus was associated with a higher use of nonprescription medications. CONCLUSION In patients with CVD, the routine use of nonprescription medications was common for a number of reasons. Health care providers should proactively discuss nonprescription use with their CVD patients to avoid potential harmful outcomes.
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Affiliation(s)
- Eman M. Shorog
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Khalid A. Alburikan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Weng SC, Wu CL, Kor CT, Chiu PF, Wu MJ, Chang CC, Tarng DC. Migraine and subsequent chronic kidney disease risk: a nationwide population-based cohort study. BMJ Open 2017; 7:e018483. [PMID: 29284721 PMCID: PMC5770945 DOI: 10.1136/bmjopen-2017-018483] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We compared the incidence and risk of chronic kidney disease (CKD) between subjects with new-onset migraine and matched controls without migraine in this large-scale retrospective cohort study. DESIGN Population-based cohort study. SETTING 8880 subjects with migraine and 503 070 subjects without migraine were enrolled between January 1, 2000 and December 31, 2013, all diagnosed to be without kidney disease. All the participants were registered in the National Health Insurance Research Database. PARTICIPANTS Finally, data from 7156 subjects with migraine and 7156 propensity-score-matched control subjects were analysed. PRIMARY OUTCOME MEASURE We used Cox proportional hazards regression to estimate adjusted HRs for incident CKD; subgroup analyses were performed to assess the interactive effects of migraine with demographics, comorbidities and long-term medications. RESULTS The incidence of CKD was higher in the migraine group than in the control group. The risk of developing CKD was significantly higher in subjects with migraine than without migraine (P=0.031). Subjects with migraine aged <65 years (age 40-64 (adjusted HR (aHR) 1.35; 95% CI 1.05 to 1.73); age <40 (aHR 1.55; 95% CI 1.02 to 2.36)), with ≥1 comorbid diseases (1-2 diseases (aHR 1.30; 95% CI 1.01 to 1.68); ≥3 diseases (aHR 1.45; 95% CI 1.01 to 2.07)), and not receiving anti-migraine agents (aHR 1.26; 95% CI 1.04 to 1.54) were at a higher risk of developing CKD compared with the control subjects. The interaction between migraine and comorbidities was not significant; age, male gender and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) were independent risk factors for CKD in subjects with migraine. CONCLUSION Migraine may be an independent risk factor for CKD. Young subjects with migraine, and those with comorbid conditions or without medical control, are likely to be at higher risk for CKD. Ageing, male sex and NSAIDs tend to have an association with CKD in subjects with migraine.
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Affiliation(s)
- Shuo-Chun Weng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Center for Geriatrics and Gerontology, Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Lin Wu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Fang Chiu
- Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Ju Wu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Center for Geriatrics and Gerontology, Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Chia-Chu Chang
- Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
Patients with chronic kidney disease (CKD) are at risk for complications both inherent to the disease and as a consequence of its treatment. The dangers that CKD patients face change across the spectrum of the disease. Providers who are well-versed in these safety threats are best poised to safeguard patients as their CKD progresses.
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Affiliation(s)
- Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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36
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Chan E, Hemmelgarn B, Klarenbach S, Manns B, Mustafa R, Nesrallah G, McQuillan R. Choosing Wisely: The Canadian Society of Nephrology's List of 5 Items Physicians and Patients Should Question. Can J Kidney Health Dis 2017; 4:2054358117695570. [PMID: 28321324 PMCID: PMC5347422 DOI: 10.1177/2054358117695570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/23/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose of review: The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused. Sources of information: A working group was formed from the Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee. This working group sequentially used a multistage Delphi method, a survey of CSN members, a modified Delphi process, and a comprehensive literature review to determine 10 candidate items representing potentially ineffective care in nephrology. An in-person vote by CSN members at their Annual General Meeting was used to rank each item based on their relevance to and potential impact on patients with kidney disease to derive the final 5 items on the list. Key messages: One hundred thirty-four of 609 (22%) CSN members responded to the survey, from which the CSN working group identified 10 candidate-misused items. Sixty-five CSN members voted on the ranking of these items. The top 5 recommendations selected for the final list were (1) do not initiate erythropoiesis-stimulating agents in patients with chronic kidney disease (CKD) with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia; (2) do not prescribe nonsteroidal anti-inflammatory drugs for individuals with hypertension or heart failure or CKD of all causes, including diabetes; (3) do not prescribe angiotensin-converting-enzyme inhibitors in combination with angiotensin II receptor blockers for the treatment of hypertension, diabetic nephropathy or heart failure; (4) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team; and (5) do not initiate dialysis in outpatients with CKD category G5-ND in the absence of clinical indications. Limitations: A low survey response rate of both community and academic nephrologists could contribute to sampling bias. However, the purpose of this report is to generate discussion, rather than study practice variation. Implications: These 5 evidence-based recommendations aim to improve outcomes and individualize care for patients with kidney disease, while reducing inefficiencies and preventing harm.
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Affiliation(s)
- Emilie Chan
- University Health Network, University of Toronto, Ontario, Canada
| | | | | | | | - Reem Mustafa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Rory McQuillan
- University Health Network, University of Toronto, Ontario, Canada
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Shukla A, Rai MK, Prasad N, Agarwal V. Short-Term Non-Steroid Anti-Inflammatory Drug Use in Spondyloarthritis Patients Induces Subclinical Acute Kidney Injury: Biomarkers Study. Nephron Clin Pract 2017; 135:277-286. [PMID: 28171854 DOI: 10.1159/000455167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/14/2016] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Non-steroid anti-inflammatory drug (NSAID) usage is associated with kidney injury. Rise in serum creatinine (sCr) often represents irreversible process. Thus to assess the early effects of regular NSAID use, we studied sensitive serum and urine biomarkers of kidney injury. METHODS In a protocol-based intervention study, 103 subjects were enrolled in 3 mutually exclusive groups. Group 1 included 37 healthy controls having minimal baseline NSAID exposure as per a definition, and group 2 had 41 spondyloarthritis (SpA) patients on regular NSAID therapy for >3 months. Group 3 included 25 SpA patients having minimal NSAID exposure at baseline. Blood and urine samples were collected from all the 3 groups at baseline. Furthermore, group 3 was started on 6-week regular NSAID therapy, and blood and urine samples were re-collected at 1, 6, and 12 weeks. Baseline normal kidney function as per the definition was ensured in all the subjects. Creatinine, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), cystatin-C, and microalbumin were measured in urine and serum samples to assess kidney injury. RESULTS Kidney injury biomarkers were 2-3-fold higher in SpA patients using regular NSAID therapy compared to healthy controls and SpA patients having minimal NSAID exposure (uKIM-1 and uNGAL p < 0.0001, sKIM-1 and sNGAL p = 0.001). There was no difference in sCr and estimated glomerular filtration rate using Cockcroft-Gault equation between the groups. In SpA patients started on 6 weeks of regular NSAID (group 3), biomarker levels started rising at week 1 and showed a significant rise at week 6. The levels in the patients that stopped NSAID use at 6 weeks showed reversibility at 12 weeks. CONCLUSIONS Regular NSAID use in SpA patients induces subclinical kidney injury represented by rise in biomarkers. These levels start rising as early as 7 days of regular NSAID use and are reversible on stopping the drug.
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Affiliation(s)
- Anuj Shukla
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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38
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Hsu CC, Chang YK, Hsu YH, Lo YR, Liu JS, Hsiung CA, Tsai HJ. Association of Nonsteroidal Anti-inflammatory Drug Use With Stroke Among Dialysis Patients. Kidney Int Rep 2017; 2:400-409. [PMID: 29142967 PMCID: PMC5678629 DOI: 10.1016/j.ekir.2017.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Limited studies have evaluated risk of stroke associated with the use of NSAIDs in patients with end-stage kidney disease. We examined the adverse effects of selective and nonselective NSAID use on the risk of stroke in dialysis patients. Methods A case-crossover study was conducted using medical claims data from the National Health Insurance Research Database in Taiwan. We identified patients with ischemic and hemorrhagic stroke (defined as International Classification of Diseases, 9th revision, Clinical Modification codes 433, 434, and 436 for ischemic stroke and 430 and 431 for hemorrhagic stroke) from inpatient claims during the period from 2003 to 2012. Conditional logistic regression models with adjustment for potential confounders were used to determine the effects of NSAID use on stroke. Results A total of 1190 dialysis patients with stroke were identified from 2003 to 2012. The results indicate a 1.31-fold increased risk of stroke related to NSAID use during the 30 days prior to a stroke (AOR = 1.31; 95% CI: 1.03–1.66); likewise, an excessive risk of ischemic stroke was observed (AOR = 1.34; 95% CI: 1.02–1.77). When classifying NSAIDs into selective and nonselective groups, nonselective NSAID use was significantly associated with an increased risk of stroke (AOR = 1.27; 95% CI: 1.00–1.61). Discussion In summary, the results show supportive evidence that NSAID use increased the risk of stroke in dialysis patients, which suggests the importance of closely monitoring the transient effects of initial NSAID treatment to patients on dialysis.
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Affiliation(s)
- Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Department of Health Services Administration, China Medical University, Taichuang City, Taiwan
- Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yu-Kang Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Yueh-Han Hsu
- Department of Internal Medicine, Division of Nephrology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan City, Taiwan
| | - Yu-Ru Lo
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Jia-Sin Liu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Correspondence: Hui-Ju Tsai, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.Institute of Population Health SciencesNational Health Research InstitutesZhunanMiaoli CountyTaiwan
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39
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Huang CF, Liu JC, Huang HC, Chuang SY, Chen CI, Lin KC. Longitudinal transition trajectory of gouty arthritis and its comorbidities: a population-based study. Rheumatol Int 2016; 37:313-322. [PMID: 28004164 DOI: 10.1007/s00296-016-3634-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
Abstract
The aim of the study was to investigate the longitudinal transition trajectory of gout and its comorbidities in male patients with gout in different age groups. A total of 3973 male patients who received a new diagnosis of gouty arthritis were identified from the Taiwan Longitudinal Health Insurance Database and divided into two age cohorts (<50 and ≥50 years). Each patient was individually followed from 2000 to 2009 to identify associated comorbidities, namely hypertension, hypercholesterolemia, diabetes mellitus, cardiovascular diseases, and chronic kidney disease. Two outcome measurements of stroke and all-cause cancer were further identified until 2010. The transition trajectory was divided into the following five phenotype groups: persistent hypertension combined with a high prevalence of various gout-related comorbidities, persistent hypercholesterolemia combined with a moderate prevalence of various gout-related comorbidities, persistent low prevalence of various gout-related comorbidities, moderate to high prevalence of various gout-related comorbidities, and low to high prevalence of various gout-related comorbidities. Although the younger and older patients had a similar longitudinal transition trajectory of gout-related comorbidities, the older patients had a higher 10-year likelihood of transition from a low or moderate to a high prevalence of various gout-related comorbidities. In addition, the incidences of stroke and all-cause cancer were higher in the groups with high and moderate to high prevalences of various gout-related comorbidities than in the other groups. The occurrence of gouty arthritis in different life stages can cause cluster effects involving varying degrees of comorbidities over time. The findings of the current study can provide additional knowledge and increase clinical awareness regarding the early assessment and management of gout-related comorbidities in clinical practice.
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Affiliation(s)
- Chien-Fang Huang
- Division of Quality Improvement, Joint Commission of Taiwan, 5F No. 31, Sec. 2, Sanmin Road, Banqiao District, New Taipei City, Taiwan, ROC
| | - Ju-Chi Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University - Shuang Ho Hospital, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City, Taiwan, ROC.,Department of Internal Medicine, School of Medicine, Medical College, Taipei Medical University, No. 252, Wu-Hsing Street, Taipei City, Taiwan, ROC
| | - Hui-Chuan Huang
- Accelerated Bachelor of Science in Nursing, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei City, Taiwan, ROC.,School of Nursing, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei City, Taiwan, ROC
| | - Shao-Yuan Chuang
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Miaoli County, Taiwan, ROC
| | - Chang-I Chen
- Taipei Cancer Center, Taipei Medical University, No. 252, Wu-Hsing Street, Taipei City, Taiwan, ROC.,Department of Healthcare Administration, School of Management, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei City, Taiwan, ROC
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Research Center, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, 11221, Taiwan, ROC.
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40
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Kamchatnov PR. [Improvement of the efficacy and safety of the treatment of patients with low back pain]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:28-33. [PMID: 27845312 DOI: 10.17116/jnevro201611610128-33] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low back pain (LBP) is an extremely widespread syndrome in the population. Nonsteroidal Inflammatory drugs are most frequently used in treatment of patients with LBP. The use of these drugs causes adverse effects, the risk of which can be minimized. To decrease the risk, B-group vitamins are used in the complex treatment. The possibility of simultaneous using of artrozan (meloxicam) and cyanocobalamine (B-group vitamin complex) in the treatment of LBP is considered.
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Affiliation(s)
- P R Kamchatnov
- Pirogov Russian National Research Medical University, Moscow, Russia
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41
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Heleniak Z, Cieplińska M, Szychliński T, Rychter D, Jagodzińska K, Kłos A, Kuźmiuk I, Tylicka MJ, Tylicki L, Rutkowski B, Dębska-Ślizień A. Nonsteroidal anti-inflammatory drug use in patients with chronic kidney disease. J Nephrol 2016; 30:781-786. [PMID: 27679400 PMCID: PMC5698389 DOI: 10.1007/s40620-016-0352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
Abstract
Aims Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of pain management. There are no detailed data on NSAIDs use in Poland, especially in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the frequency, circumstances, and causes of NSAIDs use as well as knowledge of their side-effects in patients with CKD. Method This cross-sectional study was conducted in 972 individuals with CKD, enrolled in a written survey originally developed by the authors. There were 574 patients with CKD stage I-IV, 414 patients after renal transplantation stage II-IV (CKDT) and 84 dialyzed patients (44 peritoneal, 40 hemodialysis). Results Among the entire study group, 16.9 % of patients used NSAIDs every day, or several times a week. The average number of tablets taken within a month was 21.8. Subgroup analysis revealed that NSAIDs were taken most often by patients on hemodialysis: 35 % of them used NSAIDs every day or several times a week (43.15 pills per month). The most common reason for using NSAIDs were bone-joint pain (29.3 %) and headache (26.2 %). Side effects of painkillers such as renal function deterioration and the possible promotion of stomach ulcers were experienced by 43.6 and 37.6 % of respondents, respectively. Conclusion Patients with CKD often take NSAIDs. This applies especially to the group of people undergoing hemodialysis, which is mainly associated with chronic osteo-articular pain. The results also show a low awareness of painkillers’ adverse effects.
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Affiliation(s)
- Zbigniew Heleniak
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland.
| | - Magdalena Cieplińska
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Tomasz Szychliński
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Dymitr Rychter
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Kalina Jagodzińska
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Alicja Kłos
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Izabela Kuźmiuk
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Marzena Jakimowicz Tylicka
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Tylicki
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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42
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Jensen GS, Drapeau C, Lenninger M, Benson KF. Clinical Safety of a High Dose of Phycocyanin-Enriched Aqueous Extract from Arthrospira (Spirulina) platensis: Results from a Randomized, Double-Blind, Placebo-Controlled Study with a Focus on Anticoagulant Activity and Platelet Activation. J Med Food 2016; 19:645-53. [PMID: 27362442 PMCID: PMC4948198 DOI: 10.1089/jmf.2015.0143] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The goal for this study was to evaluate safety regarding anticoagulant activity and platelet activation during daily consumption of an aqueous cyanophyta extract (ACE), containing a high dose of phycocyanin. Using a randomized, double-blind, placebo-controlled study design, 24 men and women were enrolled after informed consent, and consumed either ACE (2.3 g/day) or placebo daily for 2 weeks. The ACE dose was equivalent to ∼1 g phycocyanin per day, chosen based on the highest dose Generally Recognized as Safe (GRAS) by the U.S. Food and Drug Administration. Consuming ACE did not alter markers for platelet activation (P-selectin expression) or serum P-selectin levels. No changes were seen for activated partial thromboplastin time, thrombin clotting time, or fibrinogen activity. Serum levels of aspartate transaminase (AST) showed a significant reduction after 2 weeks of ACE consumption (P < .001), in contrast to placebo where no changes were seen; the difference in AST levels between the two groups was significant at 2 weeks (P < .02). Reduced levels of alanine transaminase (ALT) were also seen in the group consuming ACE (P < .08). Previous studies showed reduction of chronic pain when consuming 1 g ACE per day. The higher dose of 2.3 g/day in this study was associated with significant reduction of chronic pain at rest and when physically active (P < .05). Consumption of ACE showed safety regarding markers pertaining to anticoagulant activity and platelet activation status, in conjunction with rapid and robust relief of chronic pain. Reduction in AST and ALT suggested improvement in liver function and metabolism.
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Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med 2016; 176:473-82. [PMID: 26998708 PMCID: PMC5024734 DOI: 10.1001/jamainternmed.2015.8581] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Prescription and over-the-counter medicines and dietary supplements are commonly used, alone and together, among older adults. However, the effect of recent regulatory and market forces on these patterns is not known. OBJECTIVES To characterize changes in the prevalence of medication use, including concurrent use of prescription and over-the-counter medications and dietary supplements, and to quantify the frequency and types of potential major drug-drug interactions. DESIGN, SETTING, AND PARTICIPANTS Descriptive analyses of a longitudinal, nationally representative sample of community-dwelling older adults 62 to 85 years old. In-home interviews with direct medication inspection were conducted in 2005-2006 and again in 2010-2011. The dates of the analysis were March to November 2015. We defined medication use as the use of at least 1 prescription or over-the-counter medication or dietary supplement at least daily or weekly and defined concurrent use as the regular use of at least 2 medications. We used Micromedex to identify potential major drug-drug interactions. MAIN OUTCOMES AND MEASURES Population estimates of the prevalence of medication use (in aggregate and by therapeutic class), concurrent use, and major drug-drug interactions. RESULTS The study cohort comprised 2351 participants in 2005-2006 and 2206 in 2010-2011. Their mean age was 70.9 years in 2005-2006 and 71.4 years in 2010-2011. Fifty-three percent of participants were female in 2005-2006, and 51.6% were female in 2010-2011. The use of at least 1 prescription medication slightly increased from 84.1% in 2005-2006 to 87.7% in 2010-2011 (P = .003). Concurrent use of at least 5 prescription medications increased from 30.6% to 35.8% (P = .02). While the use of over-the-counter medications declined from 44.4% to 37.9%, the use of dietary supplements increased from 51.8% to 63.7% (P < .001 for both). There were clinically significant increases in the use of statins (33.8% to 46.2%), antiplatelets (32.8% to 43.0%), and omega-3 fish oils (4.7% to 18.6%) (P < .05 for all). In 2010-2011, approximately 15.1% of older adults were at risk for a potential major drug-drug interaction compared with an estimated 8.4% in 2005-2006 (P < .001). Most of these interacting regimens involved medications and dietary supplements increasingly used in 2010-2011. CONCLUSIONS AND RELEVANCE In this study, the use of prescription medications and dietary supplements, and concurrent use of interacting medications, has increased since 2005, with 15% of older adults potentially at risk for a major drug-drug interaction. Improving safety with the use of multiple medications has the potential to reduce preventable adverse drug events associated with medications commonly used among older adults.
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Affiliation(s)
- Dima M Qato
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago2Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health
| | - Jocelyn Wilder
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago2Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Victoria Gillet
- currently a medical student at the School of Medicine, University of Chicago, Chicago, Illinois
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland6Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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