Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation: a nationwide study

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with severe renal complications, including acute renal failure, reduced glomerular filtration rate and interstitial nephritis. Caution against NSAIDs is therefore recommended in advanced chronic kidney disease. In this study, we examined NSAID use, aetiology and comorbidity among a national cohort of patients before the initiation of chronic renal replacement therapy (RRT).

Patients initiated on chronic RRT in the period 1997-2006 were identified in the Danish National Registry on Regular Dialysis and Transplantation, including etiological diagnosis. The use of NSAID before the start of RRT was studied by linkage to the National Prescription Register and comorbidity by linkage to the National Patient Registry.

A total of 6663 patients were included in the study, and 2407 patients (36.1%) were prescribed NSAID in the 3 years before the start of RRT. These patients were older (mean age = 63.0 vs 61.4 years) and had a significantly higher degree of comorbidity (Charlson score = 2.85 vs 2.61, p < 0.05) compared with patients not treated with NSAIDs. In the 3 years leading up to RRT, the number of patients treated with NSAID each year and the cumulated median length of treatment including all NSAIDs were stable at approximately 20% and 40 days, respectively.

In this study of a nationwide group of patients, we observed a widespread use of NSAID with an unaffected high annual incidence in the 3 years leading up to the initiation of RRT.