Abstract | OBJECTIVE: The association between nonsteroidal anti-inflammatory drugs ( NSAIDs) and acute kidney injury is well established, but it is less clear whether this risk is focused with specific agents. We undertook a large pharmacoepidemiologic analysis of the risk of acute kidney injury among older adults using nonselective NSAIDs or cyclooxygenase (COX)-2 inhibitors. METHODS: Medicare beneficiaries from 2 large states with drug benefit were eligible for study. Patients were included if they filled a prescription for a nonselective NSAID or COX-2 inhibitor after more than 6 months without any such prescriptions and without a previous diagnosis of acute kidney injury. Incident acute kidney injury was ascertained from hospitalization claims within 45 days of initiating nonselective NSAID or COX-2 inhibitor therapy. Adjusted proportional hazards models estimated the relative risk of acute kidney injury associated with each agent compared with celecoxib. RESULTS: We included 183,446 patients whose mean age was 78 years; 80% were women. Acute kidney injury was identified in 870 (0.47%) of nonselective NSAID or COX-2 inhibitor users. The agents with significantly elevated risk compared with celecoxib were indomethacin (rate ratio [RR] = 2.23; 95% confidence interval [CI], 1.70-2.93), ibuprofen (RR = 1.73; 95% CI, 1.36-2.19), and rofecoxib (RR = 1.52; 95% CI, 1.26-1.83). These findings were robust in several subgroups. CONCLUSION:
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Authors | Wolfgang C Winkelmayer, Sushrut S Waikar, Helen Mogun, Daniel H Solomon |
Journal | The American journal of medicine
(Am J Med)
Vol. 121
Issue 12
Pg. 1092-8
(Dec 2008)
ISSN: 1555-7162 [Electronic] United States |
PMID | 19028206
(Publication Type: Journal Article)
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Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
- Cyclooxygenase 2 Inhibitors
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Topics |
- Aged
- Anti-Inflammatory Agents, Non-Steroidal
(adverse effects)
- Cohort Studies
- Cyclooxygenase 2 Inhibitors
(adverse effects)
- Female
- Hospitalization
- Humans
- Kidney Diseases
(chemically induced)
- Male
- Risk Factors
- Time Factors
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