Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study

Abstract

Ka Man Lai,1 Ta-Liang Chen,1–3 Chuen-Chau Chang,1,2 Hsi-Hsien Chen,4,5 Yuan-Wen Lee1,21Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 2Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 3Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 4Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; 5Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, TaiwanBackground: Pain is one of the most common symptoms experienced by patients with end-stage renal disease. Although NSAIDs may lead to adverse events, NSAID use appears to be considerably high in patients with end-stage renal disease. However, whether NSAID use is associated with an increased risk of mortality in this population remains unknown.Aim: This study aimed to investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease.Patients and methods: We used the population-based Taiwan National Health Insurance Research Database to investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease receiving dialysis. A total of 3,383 patients with newly diagnosed end-stage renal disease requiring long-term dialysis between 1998 and 2012 were included in the current study, and the study outcome was evaluated until December 31, 2013. Time-dependent Cox regression models were applied to examine the association between NSAID use and mortality risk.Results: In the study cohort, 2,623 (78%) patients used NSAIDs during the follow-up period. The median follow-up period was 4.0 years, during which 1,515 patients died. The results of multivariable analysis demonstrated that compared with NSAID nonuse, the use of any NSAIDs, nonselective NSAIDs, and selective cyclooxygenase-2 inhibitors was associated with a significantly increased risk of all-cause mortality with an adjusted HR (95% CI) of 1.39 (1.21–1.60), 1.36 (1.19–1.55), and 1.61 (1.42–1.83), respectively.Conclusion: The results suggest that NSAID use was associated with an increased risk of mortality in the patients with end-stage renal disease. Future randomized controlled trials are needed to validate these observational findings.Keywords: end-stage renal disease, NSAIDs, mortality

Keywords

• end-stage renal disease
• nonsteroidal anti-inflammatory drugs
• mortality