Association of Opioids and Nonsteroidal Anti-inflammatory Drugs With Outcomes in CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study
Date
2020Journal
American Journal of Kidney DiseasesPublisher
W.B. SaundersType
Article
Metadata
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Rationale & Objective: Safe analgesic choices are limited in chronic kidney disease (CKD). We conducted a comparative analysis of harm from opioids versus nonsteroidal anti-inflammatory drugs (NSAIDs) in CKD. Study Design: Prospective cohort study. Setting & Participants: 3,939 patients with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. Exposures: 30-day analgesic use reported at annual visits. Outcomes: A composite outcome of 50% glomerular filtration rate reduction and kidney failure requiring kidney replacement therapy (KRT), as well as the outcomes of kidney failure requiring KRT, hospitalization, and pre-kidney failure death. Analytical Approach: Marginal structural models with time-updated exposures. Results: Participants were followed up for a median of 6.84 years, with 391 (9.9%) and 612 (15.5%) reporting baseline opioid and NSAID use, respectively. Time-updated opioid use was associated with the kidney disease composite outcome, kidney failure with KRT, death (HRs of 1.4 [95% CI, 1.2-1.7], 1.4 [95% CI, 1.1-1.7], and 1.5 [95% CI, 1.2-2.0], respectively), and hospitalization (rate ratio [RR], 1.7; 95% CI, 1.6-1.9) versus opioid nonusers. Similar results were found in an analysis restricted to a subcohort of participants reporting ever using other (nonopioid and non-NSAID) analgesics or tramadol. Time-updated NSAID use was associated with increased risk for the kidney disease composite (HR, 1.2; 95% CI, 1.0-1.5) and hospitalization (RR, 1.1; 95% CI, 1.0-1.3); however, these associations were not significant in the subcohort. The association of NSAID use with the kidney disease composite outcome varied by race, with a significant risk in blacks (HR, 1.3; 95% CI, 1.0-1.7). NSAID use was associated with lower risk for kidney failure with KRT in women and individuals with glomerular filtration rate < 45 mL/min/1.73 m2 (HRs of 0.63 [95% CI, 0.45-0.88] and 0.77 [95% CI, 0.59-0.99], respectively). Limitations: Limited periods of recall of analgesic use and potential confounding by indication. Conclusions: Opioid use had a stronger association with adverse events than NSAIDs, with the latter's association with kidney disease outcomes limited to specific subgroups, notably those of black race. Copyright 2020 The AuthorsSponsors
Johns Hopkins University, JHU: UL1 TR-000424 UL1 RR-024131 Perelman School of Medicine, University of Pennsylvania National Institutes of Health, NIH National Institute of Diabetes and Digestive and Kidney Diseases, NIDDK: R01 DK090008 University of Illinois at Chicago, UIC: CTSA UL1RR029879 Kaiser Permanente, KP University of Maryland, UMD: GCRC M01 RR-16500, UL1TR000439 Tulane University: P20 GM109036 National Center for Advancing Translational Sciences, NCATS: UL1TR000003 Michigan Institute for Clinical and Health Research, MICHR: 2014.07.28 UL1TR000433Keyword
analgesicsChronic kidney disease (CKD)
COX-2 inhibitor
drug safety
end-stage renal disease (ESRD)
kidney disease progression
kidney function
non-steroidal anti-inflammatory drug (NSAID)
opioids
outcomes
pain management
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https://www.scopus.com/inward/record.uri?eid=2-s2.0-85083338392&doi=10.1053%2fj.ajkd.2019.12.010&partnerID=40&md5=82961040e401af3aa3e16aa3d03ced30; http://hdl.handle.net/10713/12661ae974a485f413a2113503eed53cd6c53
10.1053/j.ajkd.2019.12.010