Analgesia dose prescribing and estimated glomerular filtration rate decline: a general practice database linkage cohort study.
journal contributionposted on 22.10.2019, 13:39 by P Nderitu, L Doos, VY Strauss, M Lambie, SJ Davies, UT Kadam
OBJECTIVE: We aimed to quantify the short-term effect of non-steroidal anti-inflammatory drugs (NSAIDs), aspirin and paracetamol analgesia dose prescribing on estimated glomerular filtration rate (eGFR) decline in the general practice population. DESIGN: A population-based longitudinal clinical data linkage cohort study. SETTING: Two large general practices in North Staffordshire, UK. PARTICIPANTS: Patients aged 40 years and over with ≥2 eGFR measurements spaced ≥90 days apart between 1 January 2009 and 31 December 2010 were selected. EXPOSURE: Using WHO Defined Daily Dose standardised cumulative analgesia prescribing, patients were categorised into non-user, normal and high-dose groups. OUTCOME MEASURE: The primary outcome was defined as a >5 mL/min/1.73 m(2)/year eGFR decrease between the first and last eGFR. Logistic regression analyses were used to estimate risk, adjusting for sociodemographics, comorbidity, baseline chronic kidney disease (CKD) status, renin-angiotensin-system inhibitors and other analgesia prescribing. RESULTS: There were 4145 patients (mean age 66 years, 55% female) with an analgesia prescribing prevalence of 17.2% for NSAIDs, 39% for aspirin and 22% for paracetamol and stage 3-5 CKD prevalence was 16.1% (n=667). Normal or high-dose NSAID and paracetamol prescribing was not significantly associated with eGFR decline. High-dose aspirin prescribing was associated with a reduced risk of eGFR decline in patients with a baseline (first) eGFR ≥60 mL/min/1.73 m(2); OR=0.52 (95% CI 0.35 to 0.77). CONCLUSIONS: NSAID, aspirin and paracetamol prescribing over 2 years did not significantly affect eGFR decline with a reduced risk of eGFR decline in high-dose aspirin users with well-preserved renal function. However, the long-term effects of analgesia use on eGFR decline remain to be determined.
This work was supported by the Wolfson Foundation (intercalation award to PN) and the North Staffordshire Medical Institute (academic funding to PN); CiPCA is funded by the North Staffordshire Primary Care Research Consortium and Keele University Institute for Primary Care and Health Sciences.
CitationBMJ Open, 2014, 4:e005581.
Author affiliation/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences
VersionVoR (Version of Record)
Published inBMJ Open
PublisherBMJ Publishing Group
EPIDEMIOLOGYPRIMARY CAREAcetaminophenAdultAgedAnalgesics, Non-NarcoticAnti-Inflammatory Agents, Non-SteroidalAspirinCohort StudiesData CollectionDatabases, FactualFemaleGeneral PracticeGlomerular Filtration RateHumansLogistic ModelsLongitudinal StudiesMaleMiddle AgedRenal Insufficiency, ChronicRisk Factors