Article Figures & Data
Figures
- 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.
Tables
- Table 1
Characteristics of Study Participants, by Chronic Kidney Disease Status, National Health and Nutrition Examination Survey, 1999–2004
CKD Statusa Characteristic Overall No CKDb Mild CKDc Moderate-Severe CKDd No. (%) participants 12,065 (100) 9,604 (79.6) 1,137 (9.4) 1,324 (11.0) Sociodemographic Age, mean (SD) y 51.0 (18.7) 47.2 (17.2) 57.5 (18.0) 72.9 (11.8) Sex, % Male 51.6 53.4 46.6 48.7 Female 48.4 46.6 53.4 51.3 Race/ethnicity, %e Non-Hispanic white 40.1 41.3 37.6 37.7 Non-Hispanic black 24.8 23.5 24.6 28.2 Mexican-American 25.5 25.7 27.1 24.7 Household Income, % <$20,000 25.7 23.7 31.1 29.3 $20,000–44,999 32.9 32.6 33.6 33.5 $45,000–74,999 20.6 21.3 19.1 19.3 >$75,000 20.8 22.4 16.2 18.0 Education, % Less than high school 49.5 43.0 53.0 68.3 High school graduate 50.5 57.0 47.1 31.7 Clinical BMI ≥30 kg/m2, % No 75.8 73.0 69.1 85.3 Yes 24.2 27.0 30.9 14.7 Diabetes (self-reported), % No 93.2 95.0 80.6 92.7 Yes 6.8 5.0 19.5 7.4 Hypertension (self-reported, use of medications, or ≥140/90 mm Hg), % No 50.3 60.9 37.1 19.4 Yes 49.7 39.1 62.9 80.6 Cardiovascular disease (self-reported), % No 88.1 92.3 82.2 71.5 Yes 11.9 7.7 17.8 28.5 Cancer (self-reported), % No 90.8 92.8 89.8 81.4 Yes 9.3 7.2 10.2 18.7 Arthritis (self-reported), % No 72.4 76.6 65.0 56.2 Yes 27.6 23.4 35.0 43.8 Last visit to health care clinician, % >1 y ago 17.0 18.9 14.0 13.3 Within last year 83.0 81.1 86.0 86.8 ACEI or ARB prescription, % No 95.5 96.1 92.1 95.0 Yes 4.5 3.9 7.9 5.0 Loop diuretic prescription, % No 97.7 98.9 95.8 95.3 Yes 2.3 1.1 4.2 4.7 CKD awareness, % No 92.5 95.6 89.8 Yes 7.5 4.4 10.2 -
ACR = albumin-creatinine ratio; ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; BMI = body mass index; CKD = chronic kidney disease; eGFR=estimated glomerular filtration rate.
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Note: Estimates are unweighted study population (not US population) estimates.
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↵a P <.001 for all comparisons across CKD status, by analysis of variance (continuous variables) and χ2 (categorical variables).
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↵b ACR ≤30 mg/g, eGFR ≥60 mL/min/1.73 m2.
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↵c Stages 1 and 2 (ACR ≥30 mg/g).
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↵d Stages 3 and 4 (eGFR 15–59 mL/min/1.73 m2)
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↵e Other race excluded from analysis of race/ethnicity because of small n, but individuals from this group are included in other comparisons.
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The Article in Brief
Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States
Laura Plantinga , and colleagues
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with kidney injury and progression of kidney disease. As a result, it is recommend that most patients with chronic kidney disease (CKD) avoid NSAIDs. Little is known, however, about patterns of NSAID use among those with CKD in community settings. This study describes the prevalence and patterns of self-reported NSAID use among adults with CKD.
What This Study Found Large numbers of people with CKD, many of whom are unaware of their condition, are using NSAIDs and may be at risk for further kidney injury. Among 12,065 adults, current use of any NSAID is reported by 2.5 percent, 2.5 percent and 5 percent of patients with no, mild, and moderate to severe CKD, respectively. Nearly all NSAIDs used are over-the-counter. Among those with moderate to severe CKD who currently use NSAIDs, 10 percent have a current NSAID prescription, and 66 percent have used NSAIDs for more than 1 year.
Implications
- The authors recommend that primary care physicians, who are likely to manage both early-stage CKD and indications for NSAID use, be aware of rates of NSAID use (both prescribed and over-the-counter), assess the risk of such use, and engage patients in informed decision making about the risks and benefits of using NSAIDs.
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