Dr. Lafrance has no significant conflict of interest. Dr. Miller has received research grant funds (but not salary support) from Merck, Boehringer-Ingelheim, GlaxoSmithKline, and Sanofi-Aventis.
Selective and non-selective non-steroidal anti-inflammatory drugs and the risk of acute kidney injury†
Article first published online: 7 JUL 2009
Copyright © 2009 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 18, Issue 10, pages 923–931, October 2009
How to Cite
Lafrance, J.-P. and Miller, D. R. (2009), Selective and non-selective non-steroidal anti-inflammatory drugs and the risk of acute kidney injury. Pharmacoepidem. Drug Safe., 18: 923–931. doi: 10.1002/pds.1798
- Issue published online: 29 SEP 2009
- Article first published online: 7 JUL 2009
- Manuscript Accepted: 1 JUN 2009
- Manuscript Revised: 30 APR 2009
- Manuscript Received: 10 DEC 2008
- KRESCENT Fellowship
- VA research grant
- anti-Inflammatory agents;
- cyclooxygenase 2 inhibitors;
- kidney failure;
- case-control studies
Use of non-steroidal anti-inflammatory drugs (NSAID) is associated with risk of acute kidney injury (AKI). Risk of AKI may vary with selectivity of the NSAID, but this has not been studied in a large cohort where AKI was assessed directly from laboratory data. The objective was to compare AKI risk between selective and non-selective NSAIDs using a laboratory-based definition of AKI.
We conducted a retrospective nested case-control study in the U.S. Department of Veterans Affairs health care system. From a cohort of 1 459 271 new NSAID users, we identified 22 824 cases of AKI (97% male; mean age: 63 years), and 336 734 matched controls between 2000 and 2006. AKI was defined as a creatinine increase of greater than 50%.
We found higher risk of AKI in new users of any single NSAID (adjusted odds ratio = 1.82; 95%CI: 1.68, 1.98) compared to non-users without recent use. The risk of AKI varied among different NSAIDs with risk generally increasing with decrease in selectivity: rofecoxib (0.95; 0.64, 1.42), celecoxib (0.96; 0.63, 1.47), meloxicam (1.13; 0.63, 2.05), etodolac (1.31; 1.08, 1.59), diclofenac (1.11; 0.84, 1.48), piroxicam (1.53; 1.05, 2.23), salsalate (1.51; 1.22, 1.87), sulindac (1.61; 1.12, 2.30), ibuprofen (2.25, 2.04, 2.49), naproxen (1.72; 1.52, 1.95), high dose aspirin (3.64; 2.46, 5.37), indomethacin (1.94; 1.56, 2.42), keterolac (2.07; 1.78, 2.41). Those using multiple NSAIDs appeared to have higher risk (2.90; 2.62, 3.22).
This study provides evidence that risk of AKI may be lower with more selective agents than with naproxen or other non-selective NSAIDs. Copyright © 2009 John Wiley & Sons, Ltd.