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Wang Q, Qi Y, Gao X, Gong L, Wan R, Lei W, Wang Z, Mao J, Guan H, Li W, Walsh PJ. Recent trends and developments in the asymmetric synthesis of profens. GREEN SYNTHESIS AND CATALYSIS 2023. [DOI: 10.1016/j.gresc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Hayanga B, Stafford M, Bécares L. Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis. BMC Public Health 2023; 23:178. [PMID: 36703163 PMCID: PMC9879746 DOI: 10.1186/s12889-022-14940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.
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Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
| | - Laia Bécares
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
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Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort. Br J Gen Pract 2021; 71:e483-e490. [PMID: 33947664 PMCID: PMC8103925 DOI: 10.3399/bjgp.2020.0871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Many drugs should be avoided or require dose-adjustment in chronic kidney disease (CKD). Previous estimates of potentially inappropriate prescribing rates have been based on data on a limited number of drugs, and mainly in secondary care settings. Aim To determine the prevalence of contraindicated and potentially inappropriate primary care prescribing in a complete population of people with known CKD. Design and setting Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD, defined using laboratory data. Method Drugs were organised by British National Formulary advice — contraindicated drugs: ‘avoid’; potentially high-risk (PHR) drugs: ‘avoid if possible’; and dose-inappropriate (DI) drugs: ‘dose exceeded recommended maximums’. CKD was defined as estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73 m2 for >3 months. Results In total, 28 489 people with CKD were included in the analysis, of whom 70.1% had CKD stage 3a, 22.4% CKD stage 3b, 5.9% CKD stage 4, and 1.5% CKD stage 5. A total of 3.9% (95% confidence interval [CI] = 3.7 to 4.1) of people with CKD stages 3a–5 were prescribed ≥1 contraindicated drug, 24.3% (95% CI = 23.8 to 24.8) ≥1 PHR drug, and 15.2% (95% CI = 14.8 to 15.6) ≥1 DI drug. Contraindicated drugs differed in prevalence by CKD stage and were most commonly prescribed in CKD stage 4, with a prevalence of 36.0% (95% CI = 33.7 to 38.2). PHR drugs were commonly prescribed in all CKD stages, ranging from 19.4% (95% CI = 17.6 to 21.3) in CKD stage 4 to 25.1% (95% CI = 24.5 to 25.7) in CKD stage 3a. DI drugs were most commonly prescribed in CKD stage 4 (26.4%, 95% CI = 24.3 to 28.6). Conclusion Potentially inappropriate prescribing is common at all stages of CKD. Development and evaluation of interventions to improve prescribing safety in this high-risk population are needed.
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Katsuno T, Togo K, Ebata N, Fujii K, Yonemoto N, Abraham L, Kikuchi S. Burden of Renal Events Associated with Nonsteroidal Anti-inflammatory Drugs in Patients with Osteoarthritis and Chronic Low Back Pain: A Retrospective Database Study. Pain Ther 2021; 10:443-455. [PMID: 33439471 PMCID: PMC8119512 DOI: 10.1007/s40122-020-00233-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) have long-term benefits but are limited by side effects. We assessed the health and economic burden of renal events associated with NSAID use in patients with osteoarthritis (OA) and/or chronic low back pain (CLBP). METHODS This retrospective, large-scale, medical claims database study of Japanese patients receiving NSAIDs for OA and/or CLBP between 2009 and 2018 assessed the incidence of renal events and effect of treatment duration, mode of administration, and usage consistency of NSAIDs. RESULTS Of 180,371 patients, NSAIDs were prescribed as first-line analgesics in 89.3%. Incidence per 10,000 person-years (95% confidence interval [CI]) for renal events was 23.46 (21.84-25.08) and for progression of chronic kidney disease (CKD) was 267.12 (189.93-344.32). Longer treatment duration (> 1 to ≤ 3 years, risk ratio [RR] 1.32, 95% CI 1.12-1.54; P = 0.0007; > 3 to ≤ 5 years, RR: 1.38, 95% CI 1.04-1.84; P = 0.0254 vs. < 1 year) and consistent use (RR: 1.24, 95% CI 0.99-1.55; P = 0.0595) increased the risk of renal events but the latter did not reach statistical significance. The risk was similar in patients using patch/oral NSAIDs and high in elderly patients and in those with diabetes, hypertension, and other cardiovascular disease. Following a renal event, median 1-year cost of drug treatment was $27.90; hospitalization, $1779.40; and dialysis, $33,018.40. CONCLUSIONS Risk of renal events significantly increased with prolonged and consistent NSAID use (irrespective of mode of administration), with age, and in patients with certain comorbidities. Careful NSAID use is recommended in patients with CKD and those at high risk for CKD.
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Affiliation(s)
- Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Aichi, Japan
| | | | | | | | | | | | - Shogo Kikuchi
- Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan
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Baker M, Perazella MA. NSAIDs in CKD: Are They Safe? Am J Kidney Dis 2020; 76:546-557. [PMID: 32479922 DOI: 10.1053/j.ajkd.2020.03.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Abstract
The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have increased susceptibility to adverse drug effects due to altered drug metabolism and excretion, and there are limited safety data for use in this population despite a high pain burden. Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been regarded as dangerous for use in patients with CKD because of their risk for nephrotoxicity and thus alternative classes of analgesics, including opioids, have become more commonly used for pain control in this population. Given the well-established risks that opioids and other analgesics pose, further characterization of the risk posed by NSAIDs in patients with CKD is warranted. NSAID use has been associated with acute kidney injury, progressive loss of glomerular filtration rate in CKD, electrolyte derangements, and hypervolemia with worsening of heart failure and hypertension. The risk for these nephrotoxicity syndromes is modified by many comorbid conditions, risk factors, and characteristics of use, and in patients with CKD, the risk differs between levels of glomerular filtration rate. In this review, we offer recommendations for the cautious use of NSAIDs in the CKD population after careful consideration of these risk factors on an individualized basis.
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Affiliation(s)
- Megan Baker
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Mark A Perazella
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Medical Center, West Haven, CT.
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Imai S, Momo K, Kashiwagi H, Miyai T, Sugawara M, Takekuma Y. Nonsteroidal anti-inflammatory drugs use in patients with chronic kidney disease are often prescribed from different clinicians than those who diagnosed them. Pharmacoepidemiol Drug Saf 2020; 29:873-880. [PMID: 32410339 DOI: 10.1002/pds.5027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE When prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic kidney disease (CKD), patients' pathology and concomitant medications should be considered. In our pharmaceutical experience, NSAIDs are often prescribed by departments that are different from those that diagnosed CKD. That is, NSAIDs may be prescribed for patients without the advice of the clinicians who diagnosed them. In this study, we aimed to elucidate how frequently such cases occur. METHODS We used the large health insurance claims database constructed by JMDC Inc., Tokyo. We evaluated the proportions of CKD diagnosis and NSAID prescription by different clinical departments and institutions. RESULTS A total of 224 014 out-patients were included in the analysis; they were divided into CKD (n = 1501) and non-CKD groups (n = 222 513). The internal medicine departments diagnosed CKD most frequently (74.8% of the patients) and surgical departments rarely diagnosed CKD. However, the proportion of prescribed NSAIDs was high in other departments, especially surgical departments. In the CKD group, 50.4% of the patients received CKD diagnosis and NSAID prescription from different clinical departments; 72.8% of the patients received a diagnosis and prescription from different medical institutions. CONCLUSION Our study revealed that NSAIDs are often prescribed to patients with CKD from different clinicians than those who diagnosed them.
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Affiliation(s)
- Shungo Imai
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Hitoshi Kashiwagi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Takayuki Miyai
- Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Mitsuru Sugawara
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan.,Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
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Zhan M, Doerfler RM, Xie D, Chen J, Chen HY, Diamantidis CJ, Rahman M, Ricardo AC, Sondheimer J, Strauss L, Wagner LA, Weir MR, Fink JC. Association of Opioids and Nonsteroidal Anti-inflammatory Drugs With Outcomes in CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 2020; 76:184-193. [PMID: 32317121 DOI: 10.1053/j.ajkd.2019.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/11/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Safe analgesic choices are limited in chronic kidney disease (CKD). We conducted a comparative analysis of harm from opioids versus nonsteroidal anti-inflammatory drugs (NSAIDs) in CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,939 patients with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURES 30-day analgesic use reported at annual visits. OUTCOMES A composite outcome of 50% glomerular filtration rate reduction and kidney failure requiring kidney replacement therapy (KRT), as well as the outcomes of kidney failure requiring KRT, hospitalization, and pre-kidney failure death. ANALYTICAL APPROACH Marginal structural models with time-updated exposures. RESULTS Participants were followed up for a median of 6.84 years, with 391 (9.9%) and 612 (15.5%) reporting baseline opioid and NSAID use, respectively. Time-updated opioid use was associated with the kidney disease composite outcome, kidney failure with KRT, death (HRs of 1.4 [95% CI, 1.2-1.7], 1.4 [95% CI, 1.1-1.7], and 1.5 [95% CI, 1.2-2.0], respectively), and hospitalization (rate ratio [RR], 1.7; 95% CI, 1.6-1.9) versus opioid nonusers. Similar results were found in an analysis restricted to a subcohort of participants reporting ever using other (nonopioid and non-NSAID) analgesics or tramadol. Time-updated NSAID use was associated with increased risk for the kidney disease composite (HR, 1.2; 95% CI, 1.0-1.5) and hospitalization (RR, 1.1; 95% CI, 1.0-1.3); however, these associations were not significant in the subcohort. The association of NSAID use with the kidney disease composite outcome varied by race, with a significant risk in blacks (HR, 1.3; 95% CI, 1.0-1.7). NSAID use was associated with lower risk for kidney failure with KRT in women and individuals with glomerular filtration rate<45mL/min/1.73m2 (HRs of 0.63 [95% CI, 0.45-0.88] and 0.77 [95% CI, 0.59-0.99], respectively). LIMITATIONS Limited periods of recall of analgesic use and potential confounding by indication. CONCLUSIONS Opioid use had a stronger association with adverse events than NSAIDs, with the latter's association with kidney disease outcomes limited to specific subgroups, notably those of black race.
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Affiliation(s)
- Min Zhan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Rebecca M Doerfler
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Hsiang-Yu Chen
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Mahboob Rahman
- Department of Medicine, Case Western University, Cleveland, OH
| | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James Sondheimer
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Louise Strauss
- Department of Medicine, Case Western University, Cleveland, OH
| | - Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Davison SN, Rathwell S, George C, Hussain ST, Grundy K, Dennett L. Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2020; 7:2054358120910329. [PMID: 35186302 PMCID: PMC8851133 DOI: 10.1177/2054358120910329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/19/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Pain is common in patients with chronic kidney disease (CKD). Analgesics may be appropriate for some CKD patients. Objectives: To determine the prevalence of overall analgesic use and the use of different types of analgesics including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvants, and opioids in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with stage 3-5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of analgesic use, and the types of analgesics prescribed. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of analgesic use and the I2 statistic was computed to measure heterogeneity. Random-effects models were used to account for variations in study design and sample populations, and a double arcsine transformation of the prevalence variables was used to accommodate potential overweighting of studies with very large or very small prevalence measurements. Sensitivity analyses were performed to determine the magnitude of publication bias and assess possible sources of heterogeneity. Results: Forty studies were included in the analysis. The prevalence of overall analgesic use in the random-effects model was 50.8%. The prevalence of acetaminophen, NSAIDs, and adjuvant use was 27.5%, 17.2%, and 23.4%, respectively, while the prevalence of opioid use was 23.8%. Due to the possibility of publication bias, the actual prevalence of acetaminophen use in patients with advanced CKD may be substantially lower than this meta-analysis indicates. A trim-and-fill analysis decreased the pooled prevalence estimate of acetaminophen use to 5.4%. The prevalence rate for opioid use was highly influenced by 2 large US studies. When these were removed, the estimated prevalence decreased to 17.3%. Limitations: There was a lack of detailed information regarding the analgesic regimen (such as specific analgesics used within each class and inconsistent accounting for patients on multiple drugs and the use of over-the-counter analgesics such as acetaminophen and NSAIDs), patient characteristics, type of pain being treated, and the outcomes of treatment. Data on adjuvant use were very limited. These results, therefore, must be interpreted with caution. Conclusions: There was tremendous variability in the prescribing patterns of both nonopioid and opioid analgesics within and between countries suggesting widespread uncertainty about the optimal pharmacological approach to treating pain. Further research that incorporates robust reporting of analgesic regimens and links prescribing patterns to clinical outcomes is needed to guide optimal clinical practice.
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Affiliation(s)
- Sara N. Davison
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sarah Rathwell
- Kidney Supportive Care Research Group and Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chelsy George
- Kidney Supportive Care Research Group and Department of Medicine, University of Alberta, Edmonton, Canada
| | - Syed T. Hussain
- Kidney Supportive Care Research Group and Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Liz Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
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Abd ElHafeez S, Hegazy R, Naga Y, Wahdan I, Sallam S. Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study. J Egypt Public Health Assoc 2019; 94:8. [PMID: 30799879 PMCID: PMC6353805 DOI: 10.1186/s42506-018-0005-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided among chronic kidney disease (CKD) patients. Till now, limited data are available on NSAID use in Egypt, and we aimed to study the prevalence and pattern of NSAID use among CKD patients. METHODS A cross-sectional study was done among 350 CKD adult patients presented to the Main Alexandria University Hospital. Those with end-stage renal disease and diagnosed with acute renal injury and pregnant women were excluded. Demographic and clinical data were collected by interviewing eligible patients. Data about the pattern, history of drug-drug interactions, and knowledge about the NSAID side effects were also gathered. RESULTS Of the enrolled patients, 57.1% were hypertensive, 46% were diabetics, 28% had osteoarthritis, and 18.3% had cardiovascular disease. CKD stages were 3.7%, 40.3%, and 56% in stages 2, 3, and 4, respectively. Almost two thirds (65.7%) were NSAID users. Among them, 82.6% were regular users. Headache was the most reported (68.7%) reason of use. The use of drugs which may have drug-drug interaction with the NSAIDs (as diuretics or renin-angiotensin-aldosterone system inhibitors) was reported in 36%. In multiple logistic regression, the odds of NSAID use decreased by 4% (odds ratio (OR) = 0.96, 95% confidence interval (CI) 0.93-0.99, p = 0.01) for every year increase in the patient's age and decreased by 3% (OR = 0.97, 95% CI 0.95-0.99, p = 0.01) for every 1 ml/min/1.73 m2 increase in glomerular filtration rate. CONCLUSION Despite the hazards of NSAID use on the kidney, still high proportion of CKD patients are using them for a long period and they are simultaneously using other drugs with possible drug-drug interactions. This study provided important information that would decrease the gap in knowledge about the use of NSAID in Egypt. It is recommended that NSAIDs should be used with caution among CKD patients and patients should be advised about its adverse health consequences.
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Affiliation(s)
- Samar Abd ElHafeez
- Department of Epidemiology, High Institute of Public Health, Alexandria University, 165 ElHorreya Avenue, ElHadara, Alexandria, Egypt
| | | | - Yasmine Naga
- Department of Internal Medicine (Nephrology unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman Wahdan
- Department of Epidemiology, High Institute of Public Health, Alexandria University, 165 ElHorreya Avenue, ElHadara, Alexandria, Egypt
| | - Sunny Sallam
- Department of Epidemiology, High Institute of Public Health, Alexandria University, 165 ElHorreya Avenue, ElHadara, Alexandria, Egypt
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Zhan M, St Peter WL, Doerfler RM, Woods CM, Blumenthal JB, Diamantidis CJ, Hsu CY, Lash JP, Lustigova E, Mahone EB, Ojo AO, Slaven A, Strauss L, Taliercio JJ, Winkelmayer WC, Xie D, Fink JC. Patterns of NSAIDs Use and Their Association with Other Analgesic Use in CKD. Clin J Am Soc Nephrol 2017; 12:1778-1786. [PMID: 28811297 PMCID: PMC5672983 DOI: 10.2215/cjn.12311216] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Avoiding nonsteroidal anti-inflammatory drugs is important for safe CKD care. This study examined nonsteroidal anti-inflammatory drug use patterns and their association with other analgesic use in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Renal Insufficiency Cohort Study is an observational cohort study that enrolled 3939 adults ages 21-74 years old with CKD between 2003 and 2008 using age-based eGFR inclusion criteria. Annual visits between June of 2003 and December of 2011 were organized into 15,917 visit-pairs (with an antecedent and subsequent visit) for 3872 participants with medication information. Demographics, kidney function, and clinical factors were ascertained along with report of nonsteroidal anti-inflammatory drug or other analgesic use in the prior 30 days. RESULTS In our study, 24% of participants reported nonsteroidal anti-inflammatory drug use at baseline or at least one follow-up study visit. Having a 10 ml/min per 1.73 m2 higher eGFR level at an antecedent visit was associated with higher odds of starting nonsteroidal anti-inflammatory drugs at a subsequent visit (odds ratio, 1.44; 95% confidence interval, 1.34 to 1.56). Seeing a nephrologist at the antecedent visit was associated with lower odds of starting or staying on nonsteroidal anti-inflammatory drugs at a subsequent visit (odds ratio, 0.70; 95% confidence interval, 0.56 to 0.87 and odds ratio, 0.61; 95% confidence interval, 0.46 to 0.81, respectively). Starting and stopping nonsteroidal anti-inflammatory drugs were both associated with higher odds of increasing the number of other analgesics (odds ratio, 1.52; 95% confidence interval, 1.25 to 1.85 and odds ratio, 1.78; 95% confidence interval, 1.39 to 2.28, respectively) and higher odds of increasing the number of opioid analgesics specifically (odds ratio, 1.92; 95% confidence interval, 1.48 to 2.48 and odds ratio, 1.46; 95% confidence interval, 1.04 to 2.03, respectively). CONCLUSIONS Nonsteroidal anti-inflammatory drug use is common among patients with CKD but less so among those with worse kidney function or those who see a nephrologist. Initiation or discontinuation of nonsteroidal anti-inflammatory drugs is often associated with supplementation with or replacement by, respectively, other analgesics, including opioids, which introduces possible drug-related problems when taking these alternative analgesics.
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Affiliation(s)
- Min Zhan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Zhang X, Donnan PT, Bell S, Guthrie B. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol 2017; 18:256. [PMID: 28764659 PMCID: PMC5540416 DOI: 10.1186/s12882-017-0673-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of adverse drug events (ADEs), but renal risks of NSAIDs are less well quantified than gastrointestinal and cardiac risks. This paper reports a systematic review of published population-based observational studies examining the risk of acute kidney injury (AKI) associated with NSAIDs in community-dwelling adults and those with pre-existing chronic kidney disease (CKD). METHODS MEDLINE and EMBASE databases were searched until June 2016, and 3789 papers screened. Ten studies reporting NSAID risk of AKI in the general population were included in random effects meta-analysis, of which five additionally reported NSAID risk in people with CKD. RESULTS In the general population, the pooled odds ratio (OR) of AKI for current NSAID exposure was 1.73 (95%CI 1.44 to 2.07), with somewhat higher risk observed in older people (OR 2.51, 95%CI 1.52 to 2.68). In people with CKD, individual study OR of AKI due to current NSAID exposure ranged from 1.12 to 5.25, with pooled estimate OR 1.63 (95% CI 1.22 to 2.19). CONCLUSIONS No study reported baseline risk of AKI in different populations meaning absolute risks could not be estimated, but baseline risk and therefore the absolute risk of NSAID exposure is likely to be higher in people with CKD and older people. Large population based studies measuring AKI using current definitions and estimating the absolute risk of harm are needed in order to better inform clinical decision making.
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Affiliation(s)
- Xinyu Zhang
- Division of Population Health Sciences, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
| | - Peter T Donnan
- Division of Population Health Sciences, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
| | | | - Bruce Guthrie
- Division of Population Health Sciences, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
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Nash DM, Brimble S, Markle-Reid M, McArthur E, Tu K, Nesrallah GE, Grill A, Garg AX. Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada. Can J Kidney Health Dis 2017; 4:2054358117703059. [PMID: 28616249 PMCID: PMC5461905 DOI: 10.1177/2054358117703059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease may not be receiving recommended primary renal care. OBJECTIVE To use recently established primary care quality indicators for chronic kidney disease to determine the proportion of patients receiving recommended renal care. DESIGN Retrospective cohort study using administrative data with linked laboratory information. SETTING The study was conducted in Ontario, Canada, from 2006 to 2012. PATIENTS Patients over 40 years with chronic kidney disease or abnormal kidney function in primary care were included. MEASUREMENTS In total, 11 quality indicators were assessed for chronic kidney disease identified through a Delphi panel in areas of screening, monitoring, drug prescribing, and laboratory monitoring after initiating an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). METHODS We calculated the proportion and cumulative incidence at the end of follow-up of patients meeting each indicator and stratified results by age, sex, cohort entry, and chronic kidney disease stage. RESULTS Less than half of patients received follow-up tests after an initial abnormal kidney function result. Most patients with chronic kidney disease received regular monitoring of serum creatinine (91%), but urine albumin-to-creatinine monitoring was lower (70%). A total of 84% of patients age 66 and older did not receive a non-steroidal anti-inflammatory drug prescription of at least 2-week duration. Three quarters of patients age 66 and older were on an ACE inhibitor or ARB, and 96% did not receive an ACE inhibitor and ARB concurrently. Among patients 66 to 80 years of age with chronic kidney disease, 65% were on a statin. One quarter of patients age 66 and older who initiated an ACE inhibitor or ARB had their serum creatinine and potassium monitored within 7 to 30 days. LIMITATIONS This study was limited to people in Ontario with linked laboratory information. CONCLUSIONS There was generally strong performance across many of the quality of care indicators. Areas where more attention may be needed are laboratory testing to confirm initial abnormal kidney function test results and monitoring serum creatinine and potassium after initiating a new ACE inhibitor or ARB.
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Affiliation(s)
- Danielle M. Nash
- Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Scott Brimble
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Ontario Renal Network, Toronto, Canada
| | - Maureen Markle-Reid
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Family Health Team, Toronto Western Hospital, University Health Network, Ontario, Canada
| | - Gihad E. Nesrallah
- The Ontario Renal Network, Toronto, Canada
- Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada
| | - Allan Grill
- The Ontario Renal Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Department of Family Medicine, Markham Stouffville Hospital, Ontario, Canada
- Division of Long Term Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amit X. Garg
- Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- The Ontario Renal Network, Toronto, Canada
- Department of Medicine, London Health Sciences Centre, Ontario, Canada
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Research into practice: understanding ethnic differences in healthcare usage and outcomes in general practice. Br J Gen Pract 2015; 64:653-5. [PMID: 25452537 DOI: 10.3399/bjgp14x683053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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