Nonsteroidal anti-inflammatory drug use and risk of acute kidney injury and hyperkalemia in older adults: a population-based study. Issue 7 (26th April 2019)

• Record Type: Journal Article
• Authors: Nash, Danielle M; Markle-Reid, Maureen; Brimble, Kenneth S; McArthur, Eric; Roshanov, Pavel S; Fink, Jeffrey C; Weir, Matthew A; Garg, Amit X
• Is Part Of: Nephrology dialysis transplantation. Volume 34:Issue 7(2019)
• Page Start: 1145
• Page End: 1154
• Publication Date: 2019-04-26
• Subjects: acute kidney injury -- hyperkalemia -- nonsteroidal anti-inflammatory drugs -- prediction model; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfz062
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: Clinical guidelines caution against nonsteroidal anti-inflammatory drug (NSAID) use in older adults. The study objective was to quantify the 30-day risk of acute kidney injury (AKI) and hyperkalemia in older adults after NSAID initiation and to develop a model to predict these outcomes. Methods: We conducted a population-based retrospective cohort study in Ontario, Canada from 2007 to 2015 of patients ≥ 66 years. We matched 46 107 new NSAID users with 46 107 nonusers with similar baseline health. The primary outcome was 30-day risk of AKI and secondary outcomes were hyperkalemia and all-cause mortality. Results: NSAID use versus nonuse was associated with a higher 30-day risk of AKI {380 [0.82%] versus 272 [0.59%]; odds ratio (OR) 1.41 [95% confidence interval (CI) 1.20–1.65]} and hyperkalemia [184 (0.40%) versus 123 (0.27%); OR 1.50 (95% CI 1.20–1.89); risk difference 0.23% (95% CI 0.13–0.34)]. There was no association between NSAID use and all-cause mortality. A prediction model incorporated six predictors of AKI or hyperkalemia: older age, male gender, lower baseline estimated glomerular filtration rate, higher baseline serum potassium, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use or diuretic use. This model had moderate discrimination [C-statistic 0.72 (95% CI 0.70–0.74)] and good calibration. Conclusions: In older adults, new NSAID use compared with nonuse was associated with a higher 30-day risk of AKI and hyperkalemia but not all-cause mortality. Prescription NSAID use among many older adults may be safe, but providers should use caution and assess individual risk.