Comparative Risks of Non-Steroidal Anti-Inflammatory Drugs on Chronic Kidney Disease.

Abstract

Introduction: There have been doubts about the association between non-steroidal anti-inflammatory drugs (NSAIDs) use and worsening kidney function, and whether there is a difference between risks of individual NSAIDs is presently unclear. Therefore, this study aimed to evaluate the association between NSAID exposure and the risk of incident estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and compare the risks between NSAID subtypes in the Chinese population. Methods: From 2008 to 2017, a total of 1,982,488 subjects aged 18 years or above with baseline eGFR ≥ 60 ml/min/1.73 m2 were enrolled in this retrospective cohort study. Multivariable cox proportional hazards regression adjusted for each patient’s baseline characteristics was adopted to examine the association between NSAID and incident eGFR < 60 ml/min/1.73 m2 or eGFR decline ≥ 30% with reference to baseline. Results: After a median follow-up duration of 6.3 (interquartile range: (3.3,9.4)) years, 271,848 cases (14%) of incident eGFR < 60 ml/min/1.73 m2 and 388,386 (21%) events of eGFR decline ≥ 30% were recorded. After adjusting for each patient’s baseline characteristics, NSAID treatment was shown to be associated with a significantly higher risk of incident eGFR < 60 ml/min/1.73 m2 (HR: 1.71 [95% CI: 1.67-1.75]) and eGFR decline ≥ 30% (HR: 1.93 [95% CI: 1.89-1.96] when compared with no NSAID, with etoricoxib exhibiting the highest risk of eGFR < 60 ml/min/1.73 m2 (HR: 3.12 [95% CI: 2.69-3.62]) and eGFR decline ≥ 30% (HR: 3.11 [95% CI: 2.78 -3.48] and ibuprofen displaying the lowest risk of eGFR < 60 ml/min/1.73 m2 (HR: 1.12 [95% CI: 1.02-1.23]) and eGFR decline ≥ 30% (HR: 1.32 [95% CI: 1.23 -1.41]). Conclusions: NSAID exposure was associated with higher risks of incident eGFR < 60 ml/min/1.73 m2 and eGFR decline ≥ 30%. Highest risk was observed in etoricoxib users, and lowest risk was with ibuprofen.