Journal
FAMILY PRACTICE
Volume 30, Issue 3, Pages 247-255Publisher
OXFORD UNIV PRESS
DOI: 10.1093/fampra/cms086
Keywords
Disease progression; general practice; glomerular filtration rate; kidney disease; non-steroidal anti-inflammatory agents; systematic review
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Funding
- Wolfson Foundation
- North Staffordshire Medical Institute
- National Institutes of Health Research (NIHR) [PDA/03/07/035] Funding Source: National Institutes of Health Research (NIHR)
- National Institute for Health Research [PDA/03/07/035] Funding Source: researchfish
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Non-steroidal anti-inflammatory drugs (NSAIDs) are widely regarded as one risk factor, which influences chronic kidney disease (CKD) progression. However, previous literature reviews have not quantified the risk in moderate to severe CKD patients. To estimate the strength of association between chronic NSAID use and CKD progression. We conducted a systematic review and meta-analysis of observational general practice or population studies featuring patients aged 45 years and over. The electronic databases searched were MEDLINE, EMBASE, Cochrane, AMED, BNI and CINAHL until September 2011 without date or language restrictions. Searches included the reference lists of relevant identified studies, WEB of KNOWLEDGE, openSIGLE, specific journals, the British Library and expert networks. For relevant studies, random effects meta-analysis was used to estimate the association between NSAID use and accelerated CKD progression (estimated glomerular filtration rate decline 15ml/min/1.73 m2). From a possible 768 articles, after screening and selection, seven studies were identified (5 cohort, 1 casecontrol and 1 cross-sectional) and three were included in the meta-analysis. Regular-dose NSAID use did not significantly affect the risk of accelerated CKD progression; pooled odds ratio (OR) 0.96 (95%CI: 0.861.07), but high-dose NSAID use significantly increased the risk of accelerated CKD progression; pooled OR 1.26 (95%CI: 1.061.50). The avoidance of NSAIDs in the medium term is unnecessary in patients with moderate to severe CKD, if not otherwise contraindicated. As the definition of high-dose of NSAID use remains unclear, the lowest effective dose of NSAIDs should be prescribed where indicated.
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