Association between nonsteroidal anti-inflammatory drug use and major adverse cardiovascular events in patients with end
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ORIGINAL ARTICLE
Association between nonsteroidal anti‑inflammatory drug use and major adverse cardiovascular events in patients with end‑stage renal disease: a population‑based cohort study Yu‑Chen Liao1 · Chuen‑Chau Chang1,2 · Ta‑Liang Chen2,3 · Chih‑Chung Liu1,2 · Hsi‑Hsien Chen4,5 · Yuan‑Wen Lee1,2 Received: 12 April 2020 / Accepted: 8 August 2020 © Italian Society of Nephrology 2020
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. Keywords End-stage renal disease · Nonsteroidal anti-inflammatory drugs · Major adverse cardiovascular events · Pain
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00830-0) contains supplementary material, which is available to authorized users. * Yuan‑Wen Lee [email protected] 1
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
2
Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
3
Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
4
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
5
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Introduction Pain is common in patients wit
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