Analgesia dose prescribing and estimated glomerular filtration rate decline: a general practice database linkage cohort study

Nderitu, P.; Doos, L.; Strauss, V. Y.; Lambie, M.; Davies, S. J.; Kadam, U. T.

Abstract

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 m2/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 m2; 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.

Citation

Nderitu, P., Doos, L., Strauss, V. Y., Lambie, M., Davies, S. J., & Kadam, U. T. (2014). Analgesia dose prescribing and estimated glomerular filtration rate decline: a general practice database linkage cohort study. BMJ Open, 4(8), e005581-e005581. https://doi.org/10.1136/bmjopen-2014-005581

• Journal Article Type: Article
• Online Publication Date: Aug 19, 2014
• Publication Date: Aug 19, 2014
• Deposit Date: Nov 29, 2023
• Journal: BMJ Open
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 8
• Pages: e005581-e005581
• DOI: https://doi.org/10.1136/bmjopen-2014-005581
• Keywords: General Medicine