Association between nonsteroidal anti-inflammatory drug use and major adverse cardiovascular events in patients with end-stage renal disease: a population-based cohort study.
End-stage renal disease
Major adverse cardiovascular events
Nonsteroidal anti-inflammatory drugs
Pain
Journal
Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
12
04
2020
accepted:
08
08
2020
pubmed:
26
8
2020
medline:
19
8
2021
entrez:
26
8
2020
Statut:
ppublish
Résumé
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for patients with end-stage renal disease (ESRD) despite clinical guideline recommendations that the use of NSAIDs be avoided in this population. However, the relationship between NSAID use and adverse cardiovascular events remains unclear. Thus, this study investigated the association between NSAID use and major adverse cardiovascular events (MACEs) in patients with ESRD. We used the Taiwan National Health Insurance Research Database to conduct this population-based cohort study of patients with newly diagnosed ESRD requiring long-term dialysis between 1998 and 2012. Clinical outcomes were evaluated until the end of 2013. Time-dependent Cox regression models were used to investigate the association between NSAID use and MACEs in patients with ESRD. Among 2349 patients with ESRD receiving dialysis, 1923 (82%) patients used NSAIDs during the follow-up period. Multivariable analysis revealed that compared with nonusers, NSAID users exhibited an increased risk of MACEs with an adjusted hazard ratio (HR) of 1.70 (95% confidence interval [CI] 1.22-2.36). Further analysis demonstrated a significant dose-response relationship between the cumulative use of NSAIDs and MACEs. Adjusted HRs for MACEs were 1.63 (95% CI 1.16-2.30), 1.86 (95% CI 1.22-2.83), and 1.99 (95% CI 1.24-3.20) for cumulative NSAID use of 1-30 defined daily doses (DDDs), 31-90 DDDs, and > 90 DDDs, respectively. The results of this study suggest that NSAID use may increase the risk of MACEs in patients with ESRD. Clinicians and patients with ESRD should be aware of the potential cardiovascular risks associated with NSAIDs.
Sections du résumé
BACKGROUND
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for patients with end-stage renal disease (ESRD) despite clinical guideline recommendations that the use of NSAIDs be avoided in this population. However, the relationship between NSAID use and adverse cardiovascular events remains unclear. Thus, this study investigated the association between NSAID use and major adverse cardiovascular events (MACEs) in patients with ESRD.
METHODS
METHODS
We used the Taiwan National Health Insurance Research Database to conduct this population-based cohort study of patients with newly diagnosed ESRD requiring long-term dialysis between 1998 and 2012. Clinical outcomes were evaluated until the end of 2013. Time-dependent Cox regression models were used to investigate the association between NSAID use and MACEs in patients with ESRD.
RESULTS
RESULTS
Among 2349 patients with ESRD receiving dialysis, 1923 (82%) patients used NSAIDs during the follow-up period. Multivariable analysis revealed that compared with nonusers, NSAID users exhibited an increased risk of MACEs with an adjusted hazard ratio (HR) of 1.70 (95% confidence interval [CI] 1.22-2.36). Further analysis demonstrated a significant dose-response relationship between the cumulative use of NSAIDs and MACEs. Adjusted HRs for MACEs were 1.63 (95% CI 1.16-2.30), 1.86 (95% CI 1.22-2.83), and 1.99 (95% CI 1.24-3.20) for cumulative NSAID use of 1-30 defined daily doses (DDDs), 31-90 DDDs, and > 90 DDDs, respectively.
CONCLUSIONS
CONCLUSIONS
The results of this study suggest that NSAID use may increase the risk of MACEs in patients with ESRD. Clinicians and patients with ESRD should be aware of the potential cardiovascular risks associated with NSAIDs.
Identifiants
pubmed: 32840754
doi: 10.1007/s40620-020-00830-0
pii: 10.1007/s40620-020-00830-0
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Pharmaceutical Preparations
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
441-449Subventions
Organisme : FDA HHS
ID : CCMP102-RD-015
Pays : United States
Organisme : FDA HHS
ID : CCMP102-RD-015
Pays : United States
Références
Pham PC, Khaing K, Sievers TM, Pham PM, Miller JM, Pham SV et al (2017) 2017 Update on pain management in patients with chronic kidney disease. Clin Kidney J 10:688–697
doi: 10.1093/ckj/sfx080
Santoro D, Satta E, Messina S, Costantino G, Savica V, Bellinghieri G (2013) Pain in end-stage renal disease: a frequent and neglected clinical problem. Clin Nephrol 79(Suppl 1):S2–S11
pubmed: 23249527
Barakzoy AS, Moss AH (2006) Efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease. J Am Soc Nephrol 17:3198–3203
doi: 10.1681/ASN.2006050477
Davison SN (2003) Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis 42:1239–1247
doi: 10.1053/j.ajkd.2003.08.025
Douglas CA (2014) Palliative care for patients with advance chronic kidney disease. J R Coll Physicians Edinb 44:224–231
doi: 10.4997/JRCPE.2014.309
Davison SN, Jhangri GS (2005) The impact of chronic pain on depression, sleep, and the desire to withdraw from dialysis in hemodialysis patients. J Pain Symptom Manag 30:465–473
doi: 10.1016/j.jpainsymman.2005.05.013
Kurella M, Bennett WM, Chertow GM (2003) Analgesia in patients with ESRD: a review of available evidence. Am J Kidney Dis 42:217–228
doi: 10.1016/S0272-6386(03)00645-0
Gooch K, Culleton BF, Manns BJ, Zhang J, Alfonso H, Tonelli M et al (2007) NSAID use and progression of chronic kidney disease. Am J Med 120:280–287
doi: 10.1016/j.amjmed.2006.02.015
Shau WY, Chen HC, Chen ST, Chou HW, Chang CH, Kuo CW et al (2012) Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs): a case-crossover study of Taiwan's National Health Insurance claims database and review of current evidence. BMC Cardiovasc Disord 12:4
doi: 10.1186/1471-2261-12-4
Chang CH, Shau WY, Kuo CW, Chen ST, Lai MS (2010) Increased risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nationwide case-crossover study. Stroke 41:1884–1890
doi: 10.1161/STROKEAHA.110.585828
Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA et al (2013) Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 382:769–779
doi: 10.1016/S0140-6736(13)60900-9
Williams AW, Dwyer AC, Eddy AA, Fink JC, Jaber BL, Linas SL et al (2012) Critical and honest conversations: the evidence behind the “Choosing Wisely” campaign recommendations by the American Society of Nephrology. Clin J Am Soc Nephrol 7:1664–1672
doi: 10.2215/CJN.04970512
Rosenberg A, Agiro A, Gottlieb M, Barron J, Brady P, Liu Y et al (2015) Early trends among seven recommendations from the Choosing Wisely campaign. JAMA Intern Med 175:1913–1920
doi: 10.1001/jamainternmed.2015.5441
Heleniak Z, Cieplińska M, Szychliński T, Rychter D, Jagodzińska K, Kłos A et al (2017) Nonsteroidal anti-inflammatory drug use in patients with chronic kidney disease. J Nephrol 30:781–786
doi: 10.1007/s40620-016-0352-z
Lai KM, Chen TL, Chang CC, Chen HH, Lee YW (2019) Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study. Clin Epidemiol 11:429–441
doi: 10.2147/CLEP.S204322
Mailloux LU, Bellucci AG, Wilkes BM, Napolitano B, Mossey RT, Lesser M et al (1991) Mortality in dialysis patients: analysis of the causes of death. Am J Kidney Dis 18:326–335
doi: 10.1016/S0272-6386(12)80091-6
Feldreich T, Nowak C, Fall T, Carlsson AC, Carrero JJ, Ripsweden J et al (2019) Circulating proteins as predictors of cardiovascular mortality in end-stage renal disease. J Nephrol 32:111–119
doi: 10.1007/s40620-018-0556-5
Devine PA, Courtney AE, Maxwell AP (2019) Cardiovascular risk in renal transplant recipients. J Nephrol 32:389–399
doi: 10.1007/s40620-018-0549-4
Gislason GH, Søren J, Rasmussen JN, Søren R, Buch P, Friberg J et al (2006) Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction. Circulation 113:2906–2913
doi: 10.1161/CIRCULATIONAHA.106.616219
Gislason GH, Rasmussen JN, Abildstrom SZ, Schramm TK, Hansen ML, Fosbøl EL et al (2009) Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. Arch Intern Med 169:141–149
doi: 10.1001/archinternmed.2008.525
Huang WF, Hsiao FY, Wen YW, Tsai YW (2006) Cardiovascular events associated with the use of four nonselective NSAIDs (etodolac, nabumetone, ibuprofen, or naproxen) versus a cyclooxygenase-2 inhibitor (celecoxib): a population-based analysis in Taiwanese adults. Clin Ther 28:1827–1836
doi: 10.1016/j.clinthera.2006.11.009
Lee YW, Chen TL, Shih YR, Tsai CL, Chang CC, Liang HH et al (2014) Adjunctive traditional Chinese medicine therapy improves survival in patients with advanced breast cancer: a population-based study. Cancer 120:1338–1344
doi: 10.1002/cncr.28579
Hsieh CY, Su CC, Shao SC, Sung SF, Lin SJ, Kao Yang YH et al (2019) Taiwan’s National Health Insurance Research Database: past and future. Clin Epidemiol 11:349–358
doi: 10.2147/CLEP.S196293
Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619
doi: 10.1016/0895-4356(92)90133-8
Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C et al (2011) Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation 123:2226–2235
doi: 10.1161/CIRCULATIONAHA.110.004671
Odom DM, Mladsi DM, Saag KG, Sherif BN, Miles L, Ronquest N et al (2014) Relationship between diclofenac dose and risk of gastrointestinal and cardiovascular events: meta-regression based on two systematic literature reviews. Clin Ther 36:906–917
doi: 10.1016/j.clinthera.2014.04.012
Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML (2011) Validation of the national health insurance research database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf 20:236–242
doi: 10.1002/pds.2087
Cheng CL, Lee CH, Chen PS, Li YH, Lin SJ, Yang YH (2014) Validation of acute myocardial infarction cases in the national health insurance research database in Taiwan. J Epidemiol 24:500–517
doi: 10.2188/jea.JE20140076
Lévesque LE, Hanley JA, Kezouh A, Suissa S (2010) Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ 340:b5087
doi: 10.1136/bmj.b5087
Jo HA, Kim DK, Park S, Kim Y, Han SS, Yang BR et al (2020) Cardiovascular risk of nonsteroidal anti-inflammatory drugs in dialysis patients: a nationwide population-based study. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfz276
doi: 10.1093/ndt/gfz276
pubmed: 31943085
Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA (2007) Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation 115:1634–1642
doi: 10.1161/CIRCULATIONAHA.106.181424
Taiwan Society of Nephrology (2015) Taiwan chronic kidney disease clinical guidelines. https://www.tsn.org.tw/UI/H/H00202.aspx . Accessed 10 Mar 2020
Hsu CC, Chang YK, Hsu YH, Lo YR, Liu JS, Hsiung CA et al (2017) Association of nonsteroidal anti-inflammatory drug use with stroke among dialysis patients. Kidney Int Rep 2:400–409
doi: 10.1016/j.ekir.2017.01.004
Ungprasert P, Srivali N, Thongprayoon C (2016) Nonsteroidal anti-inflammatory drugs and risk of incident heart failure: a systematic review and meta-analysis of observational studies. Clin Cardiol 39:111–118
doi: 10.1002/clc.22502
Grosser T, Ricciotti E, FitzGerald GA (2017) The cardiovascular pharmacology of nonsteroidal anti-inflammatory drugs. Trends Pharmacol Sci 38:733–748
doi: 10.1016/j.tips.2017.05.008
Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM et al (2011) Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 342:c7086
doi: 10.1136/bmj.c7086