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. 2019 May 31:11:429-441.
doi: 10.2147/CLEP.S204322. eCollection 2019.

Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study

Ka Man Lai  1 , Ta-Liang Chen  1   2   3 , Chuen-Chau Chang  1   2 , Hsi-Hsien Chen  4   5 , Yuan-Wen Lee  1   2
Affiliations

Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study

Ka Man Lai et al. Clin Epidemiol. .

Abstract

Background: Pain is one of the most common symptoms experienced by patients with end-stage renal disease. Although NSAIDs may lead to adverse events, NSAID use appears to be considerably high in patients with end-stage renal disease. However, whether NSAID use is associated with an increased risk of mortality in this population remains unknown. Aim: This study aimed to investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease. Patients and methods: We used the population-based Taiwan National Health Insurance Research Database to investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease receiving dialysis. A total of 3,383 patients with newly diagnosed end-stage renal disease requiring long-term dialysis between 1998 and 2012 were included in the current study, and the study outcome was evaluated until December 31, 2013. Time-dependent Cox regression models were applied to examine the association between NSAID use and mortality risk. Results: In the study cohort, 2,623 (78%) patients used NSAIDs during the follow-up period. The median follow-up period was 4.0 years, during which 1,515 patients died. The results of multivariable analysis demonstrated that compared with NSAID nonuse, the use of any NSAIDs, nonselective NSAIDs, and selective cyclooxygenase-2 inhibitors was associated with a significantly increased risk of all-cause mortality with an adjusted HR (95% CI) of 1.39 (1.21-1.60), 1.36 (1.19-1.55), and 1.61 (1.42-1.83), respectively. Conclusion: The results suggest that NSAID use was associated with an increased risk of mortality in the patients with end-stage renal disease. Future randomized controlled trials are needed to validate these observational findings.

Keywords: NSAIDs; end-stage renal disease; mortality.

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Conflict of interest statement

Dr Yuan-Wen Lee reports grants from the Taiwan Ministry of Health and Welfare, during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of study sample selection.
Figure 2
Figure 2
Subgroup analysis of association between NSAID use and all-cause mortality. The reference group was NSAID nonusers. Cardiovascular disease included myocardial infarction, congestive heart failure, peripheral vascular disease, and cerebrovascular disease.
See this image and copyright information in PMC

References

    1. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385:1975–1982. doi:10.1016/S0140-6736(14)61601-9 - DOI - PubMed
    1. Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007;14:82–99. doi:10.1053/j.ackd.2006.10.001 - DOI - PubMed
    1. Davison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis. 2003;42:1239–1247. doi:10.1053/j.ajkd.2003.08.025 - DOI - PubMed
    1. Brkovic T, Burilovic E, Puljak L. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review. Patient Prefer Adherence. 2016;10:1131–1150. - PMC - PubMed
    1. Santoro D, Satta E, Messina S, Costantino G, Savica V, Bellinghieri G. Pain in end-stage renal disease: a frequent and neglected clinical problem. Clin Nephrol. 2013;79(Suppl 1):S2–S11. - PubMed