Nonsteroidal antiinflammatory drugs and acute renal failure in elderly persons.

Griffin MR, Yared A, Ray WA.
Am J Epidemiol 2000 Mar 1;151(5):488-96.

The results of this study show that nonsteroidal antiinflammatory drugs (NSAIDs) significantly increase the risk of acute renal failure in elderly patients. The study was conducted on 1,800 patients aged 65 or older, who had been hospitalized for acute renal failure. The authors evaluated use of NSAIDs in these patients, and compared it to that of a control group of almost 10,000, randomly selected, individuals. Use of NSAIDs was associated with a 60% increased risk of acute renal failure, compared to non-use. Since acute renal failure is associated with important mortality in this age group, particular caution is warranted when prescribing this class of drugs to frail, elderly individuals with or without concomitant renal disease.

Nonsteroidal anti-inflammatory drugs and the risk of hospitalization for acute renal failure.

P´erez Gutthann S; Garc´ia Rodr´iguez LA; Raiford DS; Duque Oliart A; Ris Romeu J.
Arch Intern Med, 156(21):2433-9 1996 Nov 25.

This study shows that current users of nonsteroidal antiinflammatory drugs (NSAIDs) have a fourfold increased risk of idiopathic acute renal failure (ARF) compared to the general population. New users of NSAIDs have an 8.5-times higher risk of ARF during the first month of use. The risk of developing ARF increases by a factor of 10 in individuals using prescriptions of high daily doses of NSAIDs.

Acute renal failure of medical type in an elderly population.

Baraldi A, Ballestri M, Rapana R, Lucchi L, Borella P, Leonelli M, Furci L, Lusvarghi E.
Nephrol Dial Transplant 1998;13 Suppl 7:25-9.

The results of this study, conducted on a cohort of 109 unselected patients with acute renal failure, show that in 39 of them (35%) the condition was caused by drugs. In particular, non-steroidal anti-inflammatory drugs and ACE-inhibitors were responsible for the occurrence of this serious and potentially lethal complication in 24 and 8 patients, respectively. These data indicate that non-steroidal anti-inflammatory drugs are an important cause of acute renal failure in the elderly.

Consumption of non-steroidal anti-inflammatory drugs and the development of functional renal impairment in elderly subjects.

Results of a case-control study.
Henry D; Page J; Whyte I; Nanra R; Hall C.
Br J Clin Pharmacol, 44(1):85-90 1997 Jul.

This study shows that users of non-steroidal anti-inflammatory drugs have, during the first week and month of treatment, a 50% and 80% increased risk of functional renal impairment, respectively, compared to nonusers. In individuals with a history of renal disease and gout/hyperuricemia, the risk increases by a factor of 6.6 and 7.2, respectively.

The renal effects of nonsteroidal anti-inflammatory drugs in older people

Findings from the Established Populations for Epidemiologic Studies of the Elderly.
Field TS, Gurwitz JH, Glynn RJ, Salive ME, Gaziano JM, Taylor JO, Hennekens CH.
J Am Geriatr Soc 1999 May;47(5):507-11.

The results of this study, conducted on more than 4,000 individuals aged 70 years and older, show that users of nonsteroidal anti-inflammatory drugs have a two-fold increased risk of having signs of kidney dysfunction (as measured by levels of serum creatinine and blood urea nitrogen), compared to nonusers.

Reversible membranous nephropathy associated with the use of nonsteroidal anti-inflammatory drugs.

Radford MG Jr, Holley KE, Grande JP, Larson TS, Wagoner RD, et al.
JAMA 1996 Aug 14;276(6):466-9.

This study, conducted on a sample population of 125 patients with stage I or early stage II membranous nephropathy, shows that 23% of them were on nonsteroidal anti-inflammatory drug (NSAID) therapy at the time the syndrome developed. In over 10% of patients the nephropathy was judged to be related to the use of these drugs.

Chronic nephrotoxicity of anti-inflammatory drugs used in the treatment of arthritis.

Segasothy M; Chin GL; Sia KK; Zulfiqar A; Samad SA.
Br J Rheumatol, 34(2):162-5 1995 Feb.

The results of this study indicate that the incidence of renal papillary necrosis and chronic renal impairment in arthritis patients with a history of long-term use of NSAIDs is 12% and 24%, respectively.

Management of acute renal failure in the elderly. Treatment options.

Mandal AK; Baig M; Koutoubi Z.
Drugs Aging, 9(4):226-50 1996 Oct.

This study illustrates how drugs are a frequent cause of acute renal failure in the elderly, with nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics being the agents most frequently implicated in renal toxicity.

Acute renal failure: clinical outcome and causes of death.

Barretti P; Soares VA.
Ren Fail, 19(2):253-7 1997 Mar.

This study shows that the incidence of acute renal failure (ARF) in hospitalized patients is 4.9/1000 patients. Over 46% of patients who develop ARF die. Nephrotoxic drugs are the main cause of ARF in 21% of cases.

Drug-induced nephrotoxicity. Aetiology, clinical features and management.

Hoitsma AJ; Wetzels JF; Koene RA.
Drug Saf, 6(2):131-47 1991 Mar-Apr.

This article describes the spectrum of renal diseases caused by a growing number of drugs, and lists, among the most nephrotoxic agents, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, captopril, amphotericin B and radiographic contrast agents.

Prevention of drug-induced nephrotoxicity in the intensive care unit.

Hock R; Anderson RJ.
J Crit Care, 10(1):33-43 1995 Mar.

This article emphasizes that 5% to 25% of patients admitted to the intensive care unit develop acute renal failure (ARF). ARF cause an increase in mortality from 15% to over 60% and prolongs hospital stay and costs. In a considerable percentage of cases, drugs, particularly aminoglycosides, nonsteroidal anti-inflammatory drugs and radiocontrast agents cause this condition.

Nephrotoxicities of nonsteroidal anti-inflammatory drugs.

Wen SF.
J Formos Med Assoc, 96(3):157-71 1997 Mar.

This article emphasizes that the risk of renal toxicity in users of nonsteroidal anti-inflammatory drugs is increased in individuals with congestive heart failure, cirrhosis, old age, history of renal disease, and volume depletion from diuretic use or other causes.