7ème Journée de la Recherche Clinique:Chronic NSAID use and long-term decline of renal function...

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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

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7ème Journée de la Recherche Clinique:Chronic NSAID use and long-term decline of renal function...

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 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 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
  7. 7. 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
  8. 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. 9. 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

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