Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study

Abstract

Background: Pain is one of the most common symptoms experienced by patients with end-stage renal disease. Although NSAIDs may lead to adverse events, NSAID use appears to be considerably high in patients with end-stage renal disease. However, whether NSAID use is associated with an increased risk of mortality in this population remains unknown.

Aim: This study aimed to investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease.

Patients and methods: We used the population-based Taiwan National Health Insurance Research Database to investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease receiving dialysis. A total of 3,383 patients with newly diagnosed end-stage renal disease requiring long-term dialysis between 1998 and 2012 were included in the current study, and the study outcome was evaluated until December 31, 2013. Time-dependent Cox regression models were applied to examine the association between NSAID use and mortality risk.

Results: In the study cohort, 2,623 (78%) patients used NSAIDs during the follow-up period. The median follow-up period was 4.0 years, during which 1,515 patients died. The results of multivariable analysis demonstrated that compared with NSAID nonuse, the use of any NSAIDs, nonselective NSAIDs, and selective cyclooxygenase-2 inhibitors was associated with a significantly increased risk of all-cause mortality with an adjusted HR (95% CI) of 1.39 (1.21–1.60), 1.36 (1.19–1.55), and 1.61 (1.42–1.83), respectively.

Conclusion: The results suggest that NSAID use was associated with an increased risk of mortality in the patients with end-stage renal disease. Future randomized controlled trials are needed to validate these observational findings.

Keywords:

• end-stage renal disease
• NSAIDs
• mortality

Acknowledgments

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 National Health Research Institutes. This study was supported by grants from the Taiwan Ministry of Health and Welfare (CCMP102-RD-015). This manuscript was edited by Wallace Academic Editing.

Disclosure

Dr Yuan-Wen Lee reports grants from the Taiwan Ministry of Health and Welfare, during the conduct of the study. The authors report no other conflicts of interest in this work.

Supplementary materials

Table S1 All analyzed nonsteroidal anti-inflammatory drugs (NSAIDs) in this study

Table S2 Dose–response associations between the use of individual NSAIDs and the risk of all-cause mortality in patients with end-stage renal disease