Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States

Abstract

Purpose: Because avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States.

Methods: A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999-2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defined by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥ 30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular filtration rate of 15-59 mL/min/1.73 m(2)). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting.

Results: Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P=.979).

Conclusions: Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.

Figure 1

Flowchart of cumulative study participant exclusions. eGFR=estimated glomerular filtration rate; NHANES = National Health and Nutrition Examination Survey.

Figure 2

Questionnaire items and study definitions for reported over-the-counter and prescription NSAID use, National Health and Nutrition Examination Survey, 1999–2004. NSAID=nonsteroidal anti-inflammatory drug.

Figures 3A and B

Crude reported use of nonsteroidal anti-inflammatory drugs in the US population by chronic kidney disease status, National Health and Nutrition Examination Survey, 1999–2004. CKD=chronic kidney disease; NSAID=nonsteroidal anti-inflammatory drug; OTC = over-the-counter; Rx=prescription. Note: P >.05 across CKD categories by χ², except where indicated. OTC drugs included ibuprofen and naproxen; Rx-only drugs included sulindac, piroxicam, indomethacin, tolmetin, diclofenac, celecoxib, and rofecoxib. Prescription NSAIDs included ibuprofen, naproxen, sulindac, piroxicam, indomethacin, tolmetin, diclofenac, nimesulide, meclofenamate, etodolac, ketorolac, flurbiprofen, and ketoprofen. ^a Unreliable estimates because of small sample sizes.

Figures 3A and B

Crude reported use of nonsteroidal anti-inflammatory drugs in the US population by chronic kidney disease status, National Health and Nutrition Examination Survey, 1999–2004. CKD=chronic kidney disease; NSAID=nonsteroidal anti-inflammatory drug; OTC = over-the-counter; Rx=prescription. Note: P >.05 across CKD categories by χ², except where indicated. OTC drugs included ibuprofen and naproxen; Rx-only drugs included sulindac, piroxicam, indomethacin, tolmetin, diclofenac, celecoxib, and rofecoxib. Prescription NSAIDs included ibuprofen, naproxen, sulindac, piroxicam, indomethacin, tolmetin, diclofenac, nimesulide, meclofenamate, etodolac, ketorolac, flurbiprofen, and ketoprofen. ^a Unreliable estimates because of small sample sizes.