High cumulative exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk for rapid progression of chronic kidney disease (CKD) in older patients, new data suggest.

A team at the University of Calgary in Alberta studied 10,184 CKD patients older than 66 who were not receiving hemodialysis and had no acutely unstable renal function. Renal function was evaluated using the estimated glomerular filtration rate (GFR). Rapid progression of renal disease was defined as a GFR decrease >15 mL/min/1.73 m2 during a median follow-up of 2.75 years.

Results of the study showed that compared with nonusers, high-dose users had a 26% increased risk of rapid CKD progression, but only in patients with a mean baseline GFR of 60-89. Each 100-unit increase in daily NSAID dose was associated with decrease in GFR of 0.08 during the follow-up. Among patients with a mean GFR of 60-89, COX-2 inhibitor users experienced a 25% increased risk of rapid progression of CKD.

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The researchers concluded that nonselective NSAIDs and COX-2 inhibitors should be used with caution in older persons with CKD and that chronic exposure to any NSAID should be avoided (Am J Med. 2007;120:280.e1-280.e7).