NDT Advance Access originally published online on January 20, 2009
Nephrology Dialysis Transplantation 2009 24(6):1908-1918; doi:10.1093/ndt/gfn745
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Acetaminophen, aspirin and progression of advanced chronic kidney disease
1 Nephrology Unit, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet and University Hospital, Stockholm, Sweden 2 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden 4 Department of Statistics, University of Milano-Bicocca, Milan, Italy 5 Department of Psychiatry, Harvard Medical School, Boston, MA, USA 6 International Epidemiology Institute, Rockville, MD 7 Department of Medicine, Vanderbuilt University Medical Center, Nashville, TN, USA
Correspondence and offprint requests to: Marie Evans; E-mail: marie.evans{at}ki.se
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Abstract |
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Background. Although many studies have investigated the possible association between analgesic use (acetaminophen and aspirin) and the development of chronic kidney disease (CKD), the effect of analgesics on the progression of established CKD of any cause has not yet been investigated.
Methods. In this population-based Swedish cohort study, we investigated the decline over 5–7 years in estimated glomerular filtration rate (eGFR) among 801 patients with incident, advanced CKD (serum creatinine >3.4 mg/dL for men, >2.8 mg/dL for women for the first time) and with different analgesic exposures. Lifetime analgesic use and current regular use were ascertained through in-person interviews at inclusion while data on analgesic use during the follow-up was abstracted from the medical records at the end of the study period. A linear regression slope, based on their eGFR values during the follow-up, provided a summary of within-individual change. In the final multivariate analyses, a linear mixed effects model was implemented to assess the relation of analgesic use and change in eGFR over time.
Results. The progression rate for regular users of acetaminophen was slower than that for non-regular users (regular users progressed 0.93 mL/min/1.73 m2 per year slower than non-regular users; 95% CI 0.03, 1.8). For regular users of aspirin, the progression rate was significantly slower than that for non-regular users (regular users progressed 0.80 mL/min/1.73 m2 per year slower than non-regular users; 95% CI 0.1, 1.5). Different levels of lifetime cumulative dose of acetaminophen and aspirin did not significantly affect the progression rate.
Conclusion. We suggest that single substance acetaminophen and aspirin may be safe to use by patients with diagnosed advanced CKD stage 4–5 without an adverse effect on the progression rate of the disease.
Keywords: acetaminophen; analgesics; disease progression; epidemiology; population-based
Received for publication: 26. 8.08
Accepted in revised form: 11.12.08