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American Journal of Epidemiology Advance Access published online on September 27, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj331
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received January 20, 2006
Accepted May 1, 2006

ORIGINAL CONTRIBUTIONS

Association of Selective and Conventional Nonsteroidal Antiinflammatory Drugs with Acute Renal Failure: A Population-based, Nested Case-Control Analysis

Verena Schneider 1, Linda E. Lévesque 1, Bin Zhang 1, Thomas Hutchinson 2, and James M. Brophy 3 *

1 Division of Clinical Epidemiology, Royal Victoria Hospital, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
2 Division of Clinical Epidemiology, Royal Victoria Hospital, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Integrated Whole Person Care, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
3 Division of Clinical Epidemiology, Royal Victoria Hospital, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, Royal Victoria Hospital, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Centre Technology Assessment Unit, Royal Victoria Hospital, Montreal, Quebec, Canada

* To whom correspondence should be addressed.
James M. Brophy, E-mail: james.brophy{at}mcgill.ca


  Abstract

Conventional nonsteroidal antiinflammatory drugs (NSAIDs) are associated with acute renal failure, but cyclooxygenase-2 inhibitors have not been comparatively evaluated. The authors conducted a nested case-control study to assess the association between exposure to NSAIDs, including cyclooxygenase-2 inhibitors, and hospitalization for acute renal failure. They identified 121,722 new NSAID users older than age 65 years from the administrative health care databases of Quebec, Canada, in 1999-2002. Data for 4,228 cases and 84,540 controls matched on age and follow-up time were analyzed by using conditional logistic regression, adjusted for sex, age, health status, health care utilization measures, exposure to contrast agents, and nephrotoxic medications. The risk of acute renal failure for all NSAIDs combined was highest within 30 days of treatment initiation (adjusted rate ratio (RR) = 2.05, 95% confidence interval (CI): 1.61, 2.60) and receded thereafter. The association with acute renal failure within 30 days of therapy initiation was comparable for rofecoxib (RR = 2.31, 95% CI: 1.73, 3.08), naproxen (RR = 2.42, 95% CI: 1.52, 3.85), and nonselective, non-naproxen NSAIDs (RR = 2.30, 95% CI: 1.60, 3.32) but was borderline lower for celecoxib (RR =1.54, 95% CI: 1.14, 2.09; test for interaction comparing celecoxib with rofecoxib, p = 0.057). There was a significant association for both selective and nonselective NSAIDs with acute renal failure, but confirmatory studies are required.

Keywords: aged; anti-inflammatory agents, non-steroidal; case-control studies; cyclooxygenase 2 inhibitors; kidney failure, acute; pharmacoepidemiology.
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