Characterising risk of non-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study
Sharon X Lin,
Thomas Phillips,
David Culliford,
Christopher Edwards,
Christopher Holroyd,
Kinda Ibrahim,
Ravina Barrett,
Clare Howard,
Ruth Johnson,
Jo Adams,
Mathew Stammers,
Adam Rischin,
Paul Rutter,
Nicola Barnes,
Paul J Roderick,
Simon DS Fraser
Affiliations
Sharon X Lin
National Institute for Health Research Wessex Applied Research Collaboration, University of Southampton, Southampton General Hospital, Southampton, UK
Thomas Phillips
University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
David Culliford
National Institute for Health Research Wessex Applied Research Collaboration, University of Southampton, Southampton General Hospital, Southampton, UK
Christopher Edwards
University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
Christopher Holroyd
University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
Kinda Ibrahim
National Institute for Health Research Wessex Applied Research Collaboration, University of Southampton, Southampton General Hospital, Southampton, UK
Ravina Barrett
School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, Brighton, UK
Clare Howard
Wessex Academic Health Science Network, Southampton Science Park, Southampton, UK
Ruth Johnson
Commissioning Support Unit, NHS South, Central and West, Hampshire, UK
Jo Adams
Health Sciences, University of Southampton, Southampton, UK
Mathew Stammers
University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
Adam Rischin
Alfred Health, Melbourne, Australia
Paul Rutter
School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
Nicola Barnes
School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
Paul J Roderick
School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
Simon DS Fraser
School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions. Aim: To measure the extent of NSAID prescribing in an adult population, the degree to which patients with potential higher risk of AKI were exposed to NSAIDs, and to quantify their risk of AKI. Design & setting: Retrospective 2-year closed-cohort study. Method: A retrospective cohort of adults was identified from a pseudonymised electronic primary care database in Hampshire, UK. The cohort had clinical information, prescribing data, and complete GP- and hospital-ordered biochemistry data. NSAID exposure (minimum one prescription in a 2-month period) was categorised as never, intermittent, and continuous, and first AKI using the national AKI e-alert algorithm. Descriptive statistics and logistic regression were used to explore NSAID prescribing patterns and AKI risk. Results: The baseline population was 702 265. NSAID prescription fell from 19 364 (2.8%) to 16 251 (2.4%) over 2 years. NSAID prescribing was positively associated with older age, female sex, greater socioeconomic deprivation, and certain comorbidities (diabetes, hypertension, osteoarthritis, and rheumatoid arthritis) and negatively with cardiovascular disease (CVD) and heart failure. Among those prescribed NSAIDs, AKI was associated with older age, greater deprivation, chronic kidney disease (CKD), CVD, heart failure, diabetes, and hypertension. Conclusion: Despite generally good prescribing practice, NSAID prescribing was identified in some people at higher risk of AKI (for example, patients with CKD and older) for whom medication review and NSAID deprescribing should be considered.
