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Association between nonsteroidal anti-inflammatory drug use and major adverse cardiovascular events in patients with end-stage renal disease: a population-based cohort study

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Abstract

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for patients with end-stage renal disease (ESRD) despite clinical guideline recommendations that the use of NSAIDs be avoided in this population. However, the relationship between NSAID use and adverse cardiovascular events remains unclear. Thus, this study investigated the association between NSAID use and major adverse cardiovascular events (MACEs) in patients with ESRD.

Methods

We used the Taiwan National Health Insurance Research Database to conduct this population-based cohort study of patients with newly diagnosed ESRD requiring long-term dialysis between 1998 and 2012. Clinical outcomes were evaluated until the end of 2013. Time-dependent Cox regression models were used to investigate the association between NSAID use and MACEs in patients with ESRD.

Results

Among 2349 patients with ESRD receiving dialysis, 1923 (82%) patients used NSAIDs during the follow-up period. Multivariable analysis revealed that compared with nonusers, NSAID users exhibited an increased risk of MACEs with an adjusted hazard ratio (HR) of 1.70 (95% confidence interval [CI] 1.22–2.36). Further analysis demonstrated a significant dose–response relationship between the cumulative use of NSAIDs and MACEs. Adjusted HRs for MACEs were 1.63 (95% CI 1.16–2.30), 1.86 (95% CI 1.22–2.83), and 1.99 (95% CI 1.24–3.20) for cumulative NSAID use of 1–30 defined daily doses (DDDs), 31–90 DDDs, and > 90 DDDs, respectively.

Conclusions

The results of this study suggest that NSAID use may increase the risk of MACEs in patients with ESRD. Clinicians and patients with ESRD should be aware of the potential cardiovascular risks associated with NSAIDs.

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Acknowledgements

This study was supported by a Grant from the Taiwan Ministry of Health and Welfare (CCMP102-RD-015). This study was based in part on data from the Taiwan National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare and managed by National Health Research Institutes. The interpretations and conclusions contained herein do not represent those of the National Health Insurance Administration, Ministry of Health and Welfare or of the National Health Research Institutes. This manuscript was edited by Wallace Academic Editing.

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Authors and Affiliations

  1. Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan

    Yu-Chen Liao, Chuen-Chau Chang, Chih-Chung Liu & Yuan-Wen Lee

  2. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chuen-Chau Chang, Ta-Liang Chen, Chih-Chung Liu & Yuan-Wen Lee

  3. Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Ta-Liang Chen

  4. Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    Hsi-Hsien Chen

  5. Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Hsi-Hsien Chen

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  1. Yu-Chen Liao
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Correspondence to Yuan-Wen Lee.

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Ethics approval

This study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of obtaining informed consent from patients was waived (TMU-JIRB No. N201506025).

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Liao, YC., Chang, CC., Chen, TL. et al. Association between nonsteroidal anti-inflammatory drug use and major adverse cardiovascular events in patients with end-stage renal disease: a population-based cohort study. J Nephrol 34, 441–449 (2021). https://doi.org/10.1007/s40620-020-00830-0

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