Analysis of the association between emergency dialysis start in patients with end-stage kidney disease and non-steroidal anti-inflammatory drugs, proton-pump inhibitors, and iodinated contrast agents

Abstract

The association between the use of potentially nephrotoxic drugs [Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Iodinated Contrast Agents, Proton Pump Inhibitors (PPIs)] and emergency start of dialysis in patients with chronic kidney disease has not been well explored, although these compounds are commonly prescribed or available without prescription. In this study, the Renal Epidemiology Information Network (REIN) registry data of all patients\u2009≥\u200918 years of age who started dialysis in France in 2015 were matched with those in the French National Health Insurance Database. The association between clinical characteristics, nephrotoxic drug exposure and emergency dialysis start was investigated. Patients were categorized into four classes of NSAID and PPI exposure (new, current, past, no user) on the basis of the pre-dialysis exposure period (1–30, 31–90, and 91–365 days). For iodinated contrast agents, exposure in the 72 h and 7 days before dialysis was analyzed. Among the 8805 matched patients, 30.2% needed to start dialysis in emergency. After adjustment for socio-demographic and clinical variables, new NSAID users were more likely to experience emergency dialysis start [OR\u2009=\u20091.95; 95% CI (1.1–3.4)]. This association was higher for new than for current users [OR: 1.44; 95% CI (1.08–1.92)]. Emergency dialysis start was also associated with iodinated contrast agent exposure in the previous 7 days [OR: 1.44; 95% CI (1.2–1.7)]. No significant relationship was detected between PPIs and emergency dialysis start. Using both clinical and healthcare data, this study shows that emergency dialysis start is independently associated with recent exposure to NSAIDs and iodinated contrast agents. This suggests the need to strengthen the information given to healthcare professionals and patients with regard to nephrotoxic drugs.