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Analysis of the association between emergency dialysis start in patients with end-stage kidney disease and non-steroidal anti-inflammatory drugs, proton-pump inhibitors, and iodinated contrast agents

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Abstract

Background

The association between the use of potentially nephrotoxic drugs [Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Iodinated Contrast Agents, Proton Pump Inhibitors (PPIs)] and emergency start of dialysis in patients with chronic kidney disease has not been well explored, although these compounds are commonly prescribed or available without prescription.

Methods

In this study, the Renal Epidemiology Information Network (REIN) registry data of all patients ≥ 18 years of age who started dialysis in France in 2015 were matched with those in the French National Health Insurance Database. The association between clinical characteristics, nephrotoxic drug exposure and emergency dialysis start was investigated. Patients were categorized into four classes of NSAID and PPI exposure (new, current, past, no user) on the basis of the pre-dialysis exposure period (1–30, 31–90, and 91–365 days). For iodinated contrast agents, exposure in the 72 h and 7 days before dialysis was analyzed.

Results

Among the 8805 matched patients, 30.2% needed to start dialysis in emergency. After adjustment for socio-demographic and clinical variables, new NSAID users were more likely to experience emergency dialysis start [OR = 1.95; 95% CI (1.1–3.4)]. This association was higher for new than for current users [OR: 1.44; 95% CI (1.08–1.92)]. Emergency dialysis start was also associated with iodinated contrast agent exposure in the previous 7 days [OR: 1.44; 95% CI (1.2–1.7)]. No significant relationship was detected between PPIs and emergency dialysis start.

Conclusions

Using both clinical and healthcare data, this study shows that emergency dialysis start is independently associated with recent exposure to NSAIDs and iodinated contrast agents. This suggests the need to strengthen the information given to healthcare professionals and patients with regard to nephrotoxic drugs.

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Acknowledgements

We acknowledge all Renal Epidemiology Information Network registry participants, including the professionals who collected the data and conducted the quality control. We thank Elisabetta Andermarcher for English revisions.

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Authors and Affiliations

  1. Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France

    Aurélie Pétureau

  2. Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins), EA 7449, 35000, Rennes, France

    Aurélie Pétureau, Maxime Raffray & Sahar Bayat

  3. Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France

    Elisabeth Polard

  4. Renal Epidemiology and Information Network (REIN), Biomedicine Agency, La Plaine Saint-Denis, France

    Cécile Couchoud

  5. INSERM U1085-IRSET, University of Rennes 1, Rennes, France

    Cécile Vigneau

  6. Department of Nephrology, Rennes University Hospital Pontchaillou, Rennes, France

    Cécile Vigneau

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  1. Aurélie Pétureau
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  2. Maxime Raffray
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  4. Cécile Couchoud
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Contributions

Study concept and design: CV, SB and CC; statistical analysis: AP, MR; acquisition, analysis, or interpretation of data: all authors; drafting of the manuscript: AP, SB; critical revision of the manuscript for important intellectual content: all authors; study supervision: SB, CV.

Corresponding author

Correspondence to Aurélie Pétureau.

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Conflict of interest

The interpretation and reporting of these data are the responsibility of the authors and the authors report no conflict of interest.

Ethical approval

The Renal Epidemiology Information Network registry was approved by the relevant French committees, the Comité consultatif sur le traitement de l’information en matière de recherche (CCTIRS N°03-149) and the Commission nationale de l’informatique et des libertés (CNIL N° 903188). For population-based registries requiring exhaustiveness, French regulations require that patients be informed by the clinic that they can choose not to participate (opt-out). Patients’ data were anonymized and de-identified before extraction for analysis. Access to the databases used in the present study was obtained from the Renal Epidemiology Information Network scientific committee and the CCTIRS (N°15-1046) and CNIL (N° 916072). No consent to participate was required due to the retrospective nature of this study.

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Pétureau, A., Raffray, M., Polard, E. et al. Analysis of the association between emergency dialysis start in patients with end-stage kidney disease and non-steroidal anti-inflammatory drugs, proton-pump inhibitors, and iodinated contrast agents. J Nephrol 34, 1711–1723 (2021). https://doi.org/10.1007/s40620-020-00952-5

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