Nonsteroidal anti-inflammatory drug-associated azotemia in the very old.
Meyers Primary Care Institute; Department of Medicine
Medical Subject Headings
Aged; Aged, 80 and over; Analysis of Variance; Anti-Inflammatory Agents, Non-Steroidal; Blood Urea Nitrogen; Electrolytes; Humans; Institutionalization; Logistic Models; Prospective Studies; Risk Factors; Uremia
Health Services Research | Medicine and Health Sciences
We conducted a prospective study in 114 elderly patients to determine the renal effects of short-term therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) in the very old. Study subjects were patients in a long-term care facility (mean age, 87 years) newly begun on a regimen of NSAID therapy. For the study group as a whole, the serum urea nitrogen level rose 1.7 mmol/L 5 to 7 days after initiation of therapy, with no significant changes in serum creatinine or potassium levels. In a comparison group of 45 patients not receiving NSAID therapy, no significant change in the serum urea nitrogen level was noted during a similar period. A subgroup of 15 patients (13%) experienced a greater than 50% increase in the serum urea nitrogen level during NSAID therapy, with a mean increase of 89% (8.6 mmol/L). A return to the baseline level occurred within 14 days after discontinuation of NSAID therapy. Two factors were significantly predictors of a greater than 50% increase in the serum urea nitrogen level: concurrent loop diuretic therapy (odds ratio, 2.2) and high NSAID dose (odds ratio, 2.0). These findings suggest that reversible azotemia develops in a sizable proportion of the very old who are treated with short-term NSAID therapy.
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Citation: JAMA. 1990 Jul 25;264(4):471-5.
Gurwitz, Jerry H.; Avorn, Jerry; Ross-Degnan, Dennis; and Lipsitz, Lewis A., "Nonsteroidal anti-inflammatory drug-associated azotemia in the very old." (1990). Meyers Primary Care Institute Publications and Presentations. 179.