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Cyclooxygenase inhibition causes marked impairment of renal function in elderly subjects treated with diuretics and

Tord Juhlin1, Sven Björkman, Peter Höglund

  • 1Department of Cardiology, Malmö University Hospital, Malmö, Sweden.

European Journal of Heart Failure
|October 18, 2005
PubMed

Insights

Diclofenac impairs kidney function in elderly individuals, reducing glomerular filtration rate (GFR). This effect is worsened by ACE-inhibitor pre-treatment, highlighting potential renal risks in older adults.

Area of Science:

  • Nephrology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Angiotensin-converting enzyme (ACE)-inhibitors can initially reduce glomerular filtration rate (GFR) in heart failure patients.
  • Long-term benefits of ACE-inhibitors may be diminished by cyclooxygenase-inhibitors.

Purpose of the Study:

  • To quantify the renal effects of diclofenac in elderly healthy subjects.
  • To assess the influence of ACE-inhibitor pre-treatment on diclofenac's renal effects.

Main Methods:

  • A double-blind, cross-over study involving 14 elderly healthy subjects.
  • Subjects received oral diclofenac and placebo, with and without pre-treatment with bendroflumethiazide and enalapril to activate the renin-angiotensin system.

Main Results:

  • Diclofenac significantly decreased GFR, urine flow, and electrolyte/water clearance.
  • Pre-treatment with ACE-inhibitors exacerbated diclofenac's negative impact on GFR and urine flow.

Conclusions:

  • Acute diclofenac intake impairs renal function in elderly healthy subjects.
  • Renal impairment is more pronounced when diclofenac is administered after renin-angiotensin system activation via ACE-inhibitor pre-treatment.
Abstract

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