Chronic NSAID use and long-term decline of renal function in a prospective rheumatoid arthritis cohort study de A. Finckh 7ème Journée de la Recherche Clinique

2. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Background
• NSAIDs may cause different Adverse Events: Cardiovascular system
( HTA,  LVF,  MI), Platelet function (Prostacyclin/Thromboxan
Ratio), Gastrointestinal system (GI bleedings)
• Non-steroidal anti-inflammatory drugs (NSAIDs) may cause kidney
damage due to
 Vasoconstriction
 tubular necrosis
 acute interstitial nephritis
• RA patients commonly require more extensive NSAID use than others
• They are at increased risk of impaired renal function and renal failure

3. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Objective
Is longterm decline of glomerular filtration (eGFR estimates)
in RA patients influenced by NSAID use ?
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

4. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Methods
• 4101 patients, mean observation time 3.2 years
• Primary outcome:
 eGFR estimate according to the Cockroft-Gault formula, eGFRCG
• Secondary outcomes
 Modification of Diet in Renal Disease (eGFRMDRD)
 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation
(eGFRCKD)
 Absolute serum creatinine concentrations
• Statistical methods
 mixed models for longitudinal data
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

5. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

6. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Results
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078
In patients with preserved
baseline (eGFRCG >30
ml/min):
• eGFRCG evolved without
significant differences over
time between ‘NSAID
users’ and ‘NSAID
naive’pts (p=0.63)
• Mean change in eGFRCG
− NSAID users: - 0.87
[CI: -1.15 to -0.59] ml/min/yr
− NSAID naïve: -0.67
[CI: -1.26 to -0.09] ml/min/yr

7. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Results
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078
Effect modification by
baseline renal function:
NSAIDs were an independent
predictor for rapid renal
function decline only in
patients with baseline renal
failure (eGFRCG <30 ml/min,
CKD stages 4 or 5):
• Mean change in eGFRCG
− NSAID users CKD 1 or 2:
-1.27±0.17 ml/min/yr
− NSAID users CKD 4 or 5:
-9.98±2.12 ml/min/yr

8. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Results
Slides created by Burkhard Möller, Jan 3rd 2014
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

9. SCQM – The Swiss reference platform for research and quality management in rheumatology
NSAID use and long-term decline of renal function
Results
Slides created by Burkhard Möller, Jan 3rd 2014
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078

10. SCQM – The Swiss reference platform for research and quality management in rheumatology
Conclusion
NSAIDs had no negative impact on renal function estimates,
except in patients with advanced renal impairment.
NSAID use and long-term decline of renal function
Slides created by Burkhard Möller, Jan 3rd 2014
Ann Rheum Dis. 2013 Dec 19. doi: 10.1136/annrheumdis-2013-204078