TY - JOUR
T1 - Association of Non-Steroidal Anti-Inflammatory Drugs with Kidney Health in Ambulatory Older Adults
AU - For The Health Abc Study
AU - Amatruda, Jonathan G.
AU - Katz, Ronit
AU - Peralta, Carmen A.
AU - Estrella, Michelle M.
AU - Sarathy, Harini
AU - Fried, Linda F.
AU - Newman, Anne B.
AU - Parikh, Chirag R.
AU - Ix, Joachim H.
AU - Sarnak, Mark J.
AU - Shlipak, Michael G.
N1 - Funding Information:
This article was supported by a grant from the National Institute on Aging (2R01AG027002). The National Institute on Aging had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Amatruda was also supported by the T32 Ruth L. Kirschstein National Research Service Award (5T32DK007219‐43).
Publisher Copyright:
© 2020 The American Geriatrics Society
PY - 2021/3
Y1 - 2021/3
N2 - Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine-based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. Design: Cross-sectional and longitudinal analyses. Setting: Multicenter, community-based cohort. Participants: Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. Exposure: Prescription and over-the-counter NSAID use ascertained by self-report. Measurements: Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin-to-creatinine ratio (ACR), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) were measured in 2,999 participants; alpha-1 microglobulin (α1m), neutrophil gelatinase-associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. Results: Participants had a mean age of 74 years, 51% were female, and 41% African-American. No eGFR differences were detected between NSAID users (n = 655) and non-users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non-users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51–0.89) and lower mean urine IL-18 concentration at baseline (−11%; 95% CI = −4% to −18%), but similar mean KIM-1 (5%; 95% CI = −5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non-users did not differ significantly in the rate of eGFR decline (−2.2% vs -2.3% per year). Conclusion: Self-reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption.
AB - Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine-based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. Design: Cross-sectional and longitudinal analyses. Setting: Multicenter, community-based cohort. Participants: Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. Exposure: Prescription and over-the-counter NSAID use ascertained by self-report. Measurements: Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin-to-creatinine ratio (ACR), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) were measured in 2,999 participants; alpha-1 microglobulin (α1m), neutrophil gelatinase-associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. Results: Participants had a mean age of 74 years, 51% were female, and 41% African-American. No eGFR differences were detected between NSAID users (n = 655) and non-users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non-users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51–0.89) and lower mean urine IL-18 concentration at baseline (−11%; 95% CI = −4% to −18%), but similar mean KIM-1 (5%; 95% CI = −5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non-users did not differ significantly in the rate of eGFR decline (−2.2% vs -2.3% per year). Conclusion: Self-reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption.
KW - NSAID
KW - chronic kidney disease
KW - nephrotoxicity
KW - pharmacoepidemiology
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U2 - 10.1111/jgs.16961
DO - 10.1111/jgs.16961
M3 - Article
C2 - 33305369
AN - SCOPUS:85097565894
SN - 0002-8614
VL - 69
SP - 726
EP - 734
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 3
ER -