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Author Interview: Søren Lund Kristensen, MD

Research fellow, Dept. of Cardiology
Copenhagen University Hospital Gentofte Denmark

Publication:

Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation: a nationwide study.

Kristensen, S. L., Fosbøl, E. L., Kamper, A.-L., Køber, L., Hommel, K., Lamberts, M., Abildstrøm, S. Z., Blicher, T. M., Torp-Pedersen, C. and Gislason, G. H. (2012), Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation: a nationwide study. Pharmacoepidem. Drug Safe.. doi: 10.1002/pds.3227
What are the main findings of the study?

Use of NSAIDs may cause sodium retention, oedema, hypertension,
decreased glomerular filtration rate (GFR), hyperkalemia, and
interstitial nephritis.

The exact consequences of NSAID-therapy for the development and
progression of chronic kidney disease (CKD) are largely unknown.


Our report of all Danish patients initiating chronic renal replacement
therapy (RRT) 1997-2006, showed that 36 % of patients are prescribed
NSAID´s within 3 years and 19 % within 1 year of RRT initiation.

Due to the slow deterioration of GFR in CKD we know that a large
proportion of our study population suffered from in the years prior to
RRT-initiation.

Were any of the findings unexpected?

The fact that approx. 1 out of 3 patients initiating chronic RRT in
Denmark were prescribed NSAIDs within the prior 3 years, were much
higher than expected.

Furthermore we were surprised not to see any significant reduction in
the use of NSAIDs or cumulated length of treatment in this vulnerable
group of patients throughout the study period 1997-2006.

What should clinicians and patients take away from this study?

We find that the possibility of either clinical or subclinical kidney
disease should be well thought-out prior to initiation of
NSAID-therapy and NSAIDs should be used with caution and alternative
analgesic therapy should be considered.

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