FP368NON STERIODAL ANTI INFLAMMATORY DRUGS AMONG PRE END STAGE RENAL DISEASE PATIENTS: AN EPIDEMIOLOGICAL STUDY

Abstract

Introduction and Aims: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used pharmaceutical agents worldwide. NSAIDs are con-sidered nephrotoxic medication and should, therefore, be used with caution or be avoided completely in high-risk groups, such as chronic kidney disease (CKD) patients. In the absence of data on NSAIDs use in Egypt, we aimed to study the prevalence and pattern of NSAIDs use among pre-end-stage renal disease (pre-ESRD) patients. Method(s): A hospital based survey was done among pre-ESRD adult (aged >18 years) patients. The enrolled patients were randomly selected from those admitted to the Main Alexandria University Hospital, a tertiary referral center of 4 Egyptian gover-norates. Those with ESRD, on dialysis, had previous renal transplantation, diagnosed with acute renal injury, and pregnant women were excluded. Demographic and clinical data were collected by interviewing eligible patients after their informed consent. Glomerular filtration rate was assessed by CKD-EPI equation. CKD was classified according to KDIGO guidelines. The frequency of NSAIDs use per week during the last month, duration of use, regularity of use (at least twice a week for longer than 2 months), number of drugs used within the last month, and drug-drug interactions data were gathered. Univariate and multivariate analyses were done to identify the determi-nants of NSAIDs use Results: Of the 350 pre-ESRD patients (51.4% males, age mean6 SD 556 13 years), 57.1% were hypertensive, 46% were diabetics, 28% had osteoarthritis, and 18.3% had cardiovascular disease. CKD stages were: 3.7 %, 40.3%, and 56% in stage 2,3, and 4, respectively. Almost two-thirds (65.7%) of enrolled patients were NSAIDs users. Among them, 40% use it twice per week, 46.1% use it for > 3 years, and 82.6% are regular users. Headache was the most reported (68.7%) reason of use, and ketoprofen was the most widely used (50.3%) drug. Drug-drug interaction with diuretics or RAAS inhibitors was reported in 36%. Self-decision was the most common source (76.5%) of advice for NSAIDs use. The EGFR Zwas inversely correlated with the duration of NSAIDs in years (r=-0.25, p<0.001). Age, gender, working status, smoking, history of hypertension, osteoarthritis, and hepatitis C infection are the significant determinants of NSAIDs in uniavriate analysis (p<0.05). In multiple logistic regression, the odds of NSAIDs use decreased by 4% (Odds ratio (OR) =0.96,95% Confidence Interval (CI) 0.93-0.99, p=0.01) for every year increase in the age of the patient and decreased by 3% (OR=0.97,95%CI 0.95-0.99, p=0.01) for every 1 ml/min/1.73 m2 increase in eGFR. The NSAIDs use was higher (OR=2.66,95%CI 1.19-5.95, p=0.02) among working, hypertensive (OR= 2.60,95%CI 1.27,5.35, p=0.008), and osteoarthritis (OR=6.34, 95%CI 2.03-19.78, p<0.001) patients. Conclusion(s): The utilization of NSAIDs is widely prevalent among CKD patients. Physicians and health care workers should advise CKD patients against the use of NSAIDs and should consider renal function while prescribing nephrotoxic drugs as NSAIDs.