T. Sturmer et al., Determinants of impaired renal function with use of nonsteroidal anti-inflammatory drugs: The importance of half-life and other medications, AM J MED, 111(7), 2001, pp. 521-527
Citations number
34
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with r
enal function, but little is known about the effects of the half-life of th
ese agents, or the use of other medications, on renal function.
SUBJECTS AND METHODS: Medication use was assessed during a standardized int
erview in a cross-sectional study of 802 patients undergoing total joint re
placement because of osteoarthritis. Preoperative blood samples were used t
o estimate creatinine clearance using a standard formula that takes age, se
x, and weight into account. Impaired renal function was defined as an estim
ated creatinine clearance less than 60 mL/min (fifteenth percentile). Multi
variable logistic regression was used to estimate the adjusted odds ratios
(OR) and 95% confidence intervals (CI) for the association between NSAID us
e (alone or in combination with diuretics or angiotensin-converting enzyme
[ACE] inhibitors) and impaired renal function.
RESULTS: NSAID use per se was only marginally associated with impaired rena
l function (OR = 1.4; 95% CI, 0.9 to 2.2). This association was almost excl
usively the result of the use of NSAIDs with a half-life of 4 or more hours
(OR = 2.6; 95% Cl: 1.2 to 5.7). Patients who used diuretics with NSAIDs (O
R = 3.7; 95% Cl: 1.7 to 8.3) or without NSAIDs (OR = 3.5; 95% Cl: 1.6 to 7.
6) had a higher risk of impaired renal function than did patients using NSA
IDs alone (OR = 1.6) or none of these drugs (reference). A similar but less
pronounced pattern was observed for ACE inhibitors.
CONCLUSION: NSAID-associated impaired renal function seems to be mainly the
result of compounds with intermediate long half-life. We found no evidence
that the adverse effects of diuretics and ACE inhibitors on renal function
were greater in those who also used NSAIDs. (C) 2001 by Excerpta Medica, I
nc.