Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

We thank Dr. Fox for his comments. We also believe that PCP determination of NSAID usage and CKD status among patients would enhance efforts to delay progression of CKD. While we recognize the heavy burden and limited time of the PCP, we hope that usual methods for eliciting medication usage (i.e., lists of current medications) could be easily modified to capture NSAIDs. Particularly, the usual directive to include all over-the-counter medications and herbal supplements could include statements such as "Please include any medications taken for relieving pain or reducing fever, such as..." with both generic and brand names of NSAIDs, and medications containing NSAIDs (such as cold medications). Such information could help physicians understand both the frequency/magnitude of NSAID use and also the patient rationale for use. For example, many patients may manage chronic pain with over-the-counter NSAIDs and would suffer a decline in quality of life if all NSAIDs were withdrawn. Thus, physicians and patients together must weigh the risks and benefits of NSAID use in light of CKD status and the indications for use.

Competing interests:   None declared