Non-steroidal anti-inflammatory drugs and risk of acute adverse renal outcomes in diabetes and diabetic kidney disease

2021 ◽  
pp. 1-10
Author(s):  
Cynthia Ciwei Lim ◽  
Hanis Bte Abdul Kadir ◽  
Ngiap Chuan Tan ◽  
Andrew Teck Wee Ang ◽  
Yong Mong Bee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Singapore General Hospital ◽  
Nsaid Prescription ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

BACKGROUND: Individuals with diabetes mellitus (DM) may be susceptible to non-steroidal anti-inflammatory drug (NSAID) – induced acute kidney injury (AKI) but data on NSAID-related adverse renal events is sparse. We aimed to evaluate the risk of acute kidney injury and/or hyperkalemia after systemic NSAID among individuals with DM and diabetic chronic kidney disease (CKD). METHODS: Retrospective cohort study of 3896 adults with DM with incident prescriptions between July 2015 and December 2017 from Singapore General Hospital and SingHealth Polyclinics. Laboratory, hospitalization and medication data were retrieved from electronic medical records. The primary outcome was the incidence of AKI and/ or hyperkalemia within 30 days after prescription. RESULTS: AKI and/or hyperkalemia occurred in 13.5% of all DM and 15.8% of diabetic CKD. The association between systemic NSAID >14 days and 30-day risk of AKI and/or hyperkalemia failed to reach statistical significance in unselected DM (adjusted OR 1.62, 95% CI 0.99–2.65, p = 0.05) and diabetic CKD (adjusted OR 0.64, 95% CI 0.15–2.82, p = 0.64), but the odds of AKI and/or hyperkalemia were markedly and significantly increased when NSAID was prescribed with renin-angiotensin-aldosterone system (RAAS) blocker (adjusted OR 4.17, 95% CI 1.74–9.98, p = 0.001) or diuretic (adjusted OR 3.31, 95% CI 1.09–10.08, p = 0.04) and in the absence of diabetic CKD (adjusted OR 1.98, 95% CI 1.16–3.36, p = 0.01). CONCLUSION: NSAID prescription >14 days in individuals with DM with concurrent RAAS blockers or diuretics was associated with higher 30-day risk of AKI and/or hyperkalemia.

scholarly journals Non-steroidal anti-inflammatory drugs induced acute kidney injury: incidence, clinical presentation, management and outcomes of patients at Tertiary Hospital based longitudinal study in Mymensingh, Bangladesh

2018 ◽  
Vol 7 (2) ◽  
pp. 9-16
Author(s):  
Shamima Sattar ◽  
Mahmud Javed Hasan ◽  
Nitai Chandra Ray ◽  
ASM Ruhul Quddus
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Longitudinal Study ◽  
Kidney Disease ◽  
Renal Injury ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Injury Incidence ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in primary care for their analgesic and anti-inflammatory effects. Twelve percent of individuals currently report taking a NSAID daily. Renal injury caused by these agents can present in various forms, resulting from either acute or chronic use. Historically approximately five percent of patients initiated on NSAIDs experience a kidney-related adverse event. Drug-induced renal injury accounts for twenty percent of episodes of acute kidney injury (AKI). Patients requiring renal replacement therapy (RRT) have experienced an increased length of stay with associated healthcare costs per incident. The adverse effects of NSAIDs contribute to a significant economic burden, both to the patient and to the healthcare system.This study of NSAIDs induced AKI was carried out to highlight this issue. To find out the incidence, risk factors, diagnostic approach, clinical course, management and outcome of patients, this longitudinal study was carried out at Nephrology Department in Community Based Medical College Hospital Bangladesh from July 2015 to June 2016.Total 65 patients of NSAIDs induced AKI were included in this study. Any patient having pre existing renal pathology or chronic kidney disease was excluded from the study. Mean age of the patient was 36±7.12 yrs. Forty nine patients (74.38%) took NSAIDs at their own and 16 patients (24.61%) were prescribed by physician. Fifty six patients (86.15%) took NSAIDs because of musculoskeletal pain. Dehydration due to physical exertion (29.23%) gastroenteritis (16.92%) and nil per os (NPO) (6.15%)were the common predisposing factors. Common symptoms were swelling of the body (36.9%) headache (26.15%) fatigue (21.53%) and vomiting (13.84%) Oedema was the most common sign (36.9%) Blood urea and serum creatinine were raised in all patients. Treatment includes drug withdrawal (100%), fluid resuscitation (83.07%) fluid restriction (13.85%) short course of steroid (15.38%) and haemodialysis (10.76%) . Fifty one patients (78.46%) had complete recovery within two weeks of therapy whereas ten patients (15.38%) required more than two weeks to one month for complete recovery. Three patients (4.61%) developed chronic kidney disease (CKD). NSAIDs induced AKI carries a good prognosis with early diagnosis and proper management and it can be prevented by limiting the availability of over the counter drugs and creating awareness both in physicians and patients. These medications should be prescribed for the shortest duration, the lowest effective dose, and with careful surveillance to monitor nephrotoxicity precisely. NSAIDs should be used with special caution in elderly patients. CBMJ 2018 July: Vol. 07 No. 02 P: 09-16

scholarly journals Nonsteroidal Anti-Inflammatory Drugs Are an Important Cause of Acute Kidney Injury in Children

2013 ◽  
Vol 162 (6) ◽  
pp. 1153-1159.e1 ◽  
Author(s):  
Jason M. Misurac ◽  
Chad A. Knoderer ◽  
Jeffrey D. Leiser ◽  
Corina Nailescu ◽  
Amy C. Wilson ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals PGC1α in the kidney

2018 ◽  
Vol 314 (1) ◽  
pp. F1-F8 ◽  
Author(s):  
Matthew R. Lynch ◽  
Mei T. Tran ◽  
Samir M. Parikh
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Renal Fibrosis ◽  
Diabetic Kidney Disease ◽  
Kidney Injury ◽  
Peroxisome Proliferator ◽  
Peroxisome Proliferator Activated Receptor ◽  
The Relationship ◽  
Prime Target

Acute kidney injury (AKI) arising from diverse etiologies is characterized by mitochondrial dysfunction. The peroxisome proliferator-activated receptor γ coactivator-1alpha (PGC1α), a master regulator of mitochondrial biogenesis, has been shown to be protective in AKI. Interestingly, reduction of PGC1α has also been implicated in the development of diabetic kidney disease and renal fibrosis. The beneficial renal effects of PGC1α make it a prime target for therapeutics aimed at ameliorating AKI, forms of chronic kidney disease (CKD), and their intersection. This review summarizes the current literature on the relationship between renal health and PGC1α and proposes areas of future interest.

scholarly journals Acute Kidney Injury and Progressive Diabetic Kidney Disease: An Epidemiological Perspective

2021 ◽  
Vol Volume 14 ◽  
pp. 23-31 ◽  
Author(s):  
Ravindra Attur Prabhu ◽  
Srinivas V Shenoy ◽  
Shankar Prasad Nagaraju ◽  
Dharshan Rangaswamy ◽  
Indu Ramachandra Rao ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Kidney Injury ◽  
Diabetic Kidney
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