Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients

Michael Murray, P. K. Black, D. D. Kuzmik, K. M. Haag, A. K. Manatunga, M. A. Mullin, S. D. Hall, D. C. Brater

Research output: Contribution to journalArticle

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Abstract

To assess the effects of nonsteroidal antiinflammatory drugs (NSAIDs) on glomerular filtration rate (GFR) in elderly patients with and without renal insufficiency, we conducted an open-label, randomized, prospective three- period cross-over study. Twenty-nine patients at least 65 years old were assigned to groups with preserved GFR (> 1.16 mL/s [70 mL/min]) or with renal insufficiency (GFR 0.50-1.16 mL/s [30-70 mL/min]). Patients received 600 mg ibuprofen three times daily, 20 mg piroxicam daily, or 200 mg sulindac twice daily for 1 month. Three-hour inulin and two-day creatinine clearances were measured before and after the first and last doses of NSAIDs. Ibuprofen, piroxicam, and sulindac decreased inulin clearance after single-doses in both groups of patients. In patients with renal insufficiency, creatinine clearance did not change after administration of ibuprofen for 1 month (0 ± 0.06 mL/s, mean ± standard error), but was decreased similarly with administration of either piroxicam or sulindac (-0.12 ± 0.06 mL/s [-7.2 ± 3.6 mL/min], P < 0.02). One patient with preserved GFR, but with other risk factors for NSAID-associated renal impairment, met our criteria for withdrawal by experiencing at least a 40 μmol/L (0.5 mg/dL) increase in serum creatinine above their baseline value. Our data indicate that NSAIDs do not adversely affect GFR in patients with preserved renal function unless they have another risk factor for NSAID-associated renal impairment. In contrast, patients with renal insufficiency may have significant chronic decrements in GFR with long-acting NSAIDs such as piroxicam and sulindac, but not with short-acting ibuprofen. Such patients should have renal function monitored while being treated with long-acting NSAIDs.

Original languageEnglish
Pages (from-to)188-197
Number of pages10
JournalAmerican Journal of the Medical Sciences
Volume310
Issue number5
StatePublished - 1995

Fingerprint

Glomerular Filtration Rate
Anti-Inflammatory Agents
Sulindac
Piroxicam
Ibuprofen
Pharmaceutical Preparations
Renal Insufficiency
Kidney
Creatinine
Inulin
Cross-Over Studies
Serum

Keywords

  • Aged
  • Elderly
  • Glomerular filtration rate
  • Kidney failure, acute
  • NSAIDs

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Murray, M., Black, P. K., Kuzmik, D. D., Haag, K. M., Manatunga, A. K., Mullin, M. A., ... Brater, D. C. (1995). Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients. American Journal of the Medical Sciences, 310(5), 188-197.

Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients. / Murray, Michael; Black, P. K.; Kuzmik, D. D.; Haag, K. M.; Manatunga, A. K.; Mullin, M. A.; Hall, S. D.; Brater, D. C.

In: American Journal of the Medical Sciences, Vol. 310, No. 5, 1995, p. 188-197.

Research output: Contribution to journalArticle

Murray, M, Black, PK, Kuzmik, DD, Haag, KM, Manatunga, AK, Mullin, MA, Hall, SD & Brater, DC 1995, 'Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients', American Journal of the Medical Sciences, vol. 310, no. 5, pp. 188-197.
Murray, Michael ; Black, P. K. ; Kuzmik, D. D. ; Haag, K. M. ; Manatunga, A. K. ; Mullin, M. A. ; Hall, S. D. ; Brater, D. C. / Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients. In: American Journal of the Medical Sciences. 1995 ; Vol. 310, No. 5. pp. 188-197.
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