SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Background• NSAIDs may cause different Adverse Events: Cardiovascular system

( HTA, LVF, MI), Platelet function (Prostacyclin/Thromboxan Ratio), Gastrointestinal system (GI bleedings)

• Non-steroidal anti-inflammatory drugs (NSAIDs) may cause kidney damage due to

Vasoconstriction

tubular necrosis

acute interstitial nephritis

• RA patients commonly require more extensive NSAID use than others

• They are at increased risk of impaired renal function and renal failure

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Objective

Is longterm decline of glomerular filtration (eGFR estimates)

in RA patients influenced by NSAID use ?

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Methods• 4101 patients, mean observation time 3.2 years

• Primary outcome: eGFR estimate according to the Cockroft-Gault formula, eGFRCG

• Secondary outcomes Modification of Diet in Renal Disease (eGFRMDRD)

Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation (eGFRCKD)

Absolute serum creatinine concentrations

• Statistical methods mixed models for longitudinal data

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Results

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

In patients with preserved baseline (eGFRCG >30 ml/min):

•eGFRCG evolved without significant differences over time between ‘NSAID users’ and ‘NSAID naive’pts (p=0.63)

•Mean change in eGFRCG

−NSAID users: - 0.87 [CI: -1.15 to -0.59] ml/min/yr

−NSAID naïve: -0.67 [CI: -1.26 to -0.09] ml/min/yr

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Results

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

Effect modification by baseline renal function:

NSAIDs were an independent predictor for rapid renal function decline only in patients with baseline renal failure (eGFRCG <30 ml/min, CKD stages 4 or 5):

•Mean change in eGFRCG −NSAID users CKD 1 or 2: -1.27±0.17 ml/min/yr −NSAID users CKD 4 or 5: -9.98±2.12 ml/min/yr

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Results

Slides created by Burkhard Möller, Jan 3rd 2014

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

SCQM – The Swiss reference platform for research and quality management in rheumatology

NSAID use and long-term decline of renal function

Results

Slides created by Burkhard Möller, Jan 3rd 2014

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

SCQM – The Swiss reference platform for research and quality management in rheumatology

Conclusion

NSAIDs had no negative impact on renal function estimates,

except in patients with advanced renal impairment.

NSAID use and long-term decline of renal function

Slides created by Burkhard Möller, Jan 3rd 2014

Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078