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dc.contributor.authorZhan, M.
dc.contributor.authorDoerfler, R.M.
dc.contributor.authorWagner, L.-A.
dc.contributor.authorWeir, M.R.
dc.contributor.authorFink, J.C.
dc.contributor.authorCRIC Study Investigators
dc.date.accessioned2020-04-27T19:48:56Z
dc.date.available2020-04-27T19:48:56Z
dc.date.issued2020
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85083338392&doi=10.1053%2fj.ajkd.2019.12.010&partnerID=40&md5=82961040e401af3aa3e16aa3d03ced30
dc.identifier.urihttp://hdl.handle.net/10713/12661
dc.description.abstractRationale & 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 Authorsen_US
dc.description.sponsorshipJohns 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 UL1TR000433en_US
dc.description.urihttps://doi.org/10.1053/j.ajkd.2019.12.010en_US
dc.language.isoen_USen_US
dc.publisherW.B. Saundersen_US
dc.relation.ispartofAmerican Journal of Kidney Diseases
dc.subjectanalgesicsen_US
dc.subjectChronic kidney disease (CKD)en_US
dc.subjectCOX-2 inhibitoren_US
dc.subjectdrug safetyen_US
dc.subjectend-stage renal disease (ESRD)en_US
dc.subjectkidney disease progressionen_US
dc.subjectkidney functionen_US
dc.subjectnon-steroidal anti-inflammatory drug (NSAID)en_US
dc.subjectopioidsen_US
dc.subjectoutcomesen_US
dc.subjectpain managementen_US
dc.titleAssociation of Opioids and Nonsteroidal Anti-inflammatory Drugs With Outcomes in CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Studyen_US
dc.typeArticleen_US
dc.identifier.doi10.1053/j.ajkd.2019.12.010


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