Clinical studyDeterminants of impaired renal function with use of nonsteroidal anti-inflammatory drugs: the importance of half-life and other medications
Section snippets
Sample
Between January 1995 and December 1996, 809 consecutive patients under the age of 76 years were enrolled in four tertiary care centers in southwest Germany before replacement of a hip or knee joint because of advanced osteoarthritis. The study protocol was approved by the ethics committee of the University of Ulm, Germany. After giving written informed consent, participants were interviewed and examined by trained physicians according to a standardized questionnaire and examination procedure.
Results
The mean age of the study participants was over 60 years, and there were more women than men (Table 1). The mean body mass index was high, over 33% of participants had hypercholesterolemia, and more than 50% had hypertension. Regular daily use of any analgesic medication was common, especially NSAIDs. (With the exception of acemethacin, the most commonly used NSAIDs are also common in the United States.) Regular use of aspirin and acetaminophen was less prevalent. A quarter of patients
Discussion
Among patients with advanced osteoarthritis, we observed an only marginally increased prevalence of impaired renal function in regular users of NSAIDs compared with nonusers. Impaired renal function was more common among users of NSAIDs with an intermediate or long half-life (4 hours or longer) and in patients who also used diuretics or ACE inhibitors. The latter risks were mainly the result of the use of diuretics and ACE inhibitors per se, and we found no evidence that NSAIDs exacerbated the
Acknowledgements
We would like to thank the institutions that participated in this study: the Departments of Orthopedic Surgery (head: Dr. W. Puhl) and Trauma Surgery (Dr. L. Kinzl) of the University of Ulm, Hessing Orthopedic Hospital in Augsburg (Dr. Th. Naumann), and Baumann Orthopedic Hospital in Stuttgart (Dr. C.T. Trepte) for their efforts in recruiting the patients; Ms. B. Mack for data processing; and Dr. A. M. Walker for his valuable suggestions.
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