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Article
July 25, 1990

Nonsteroidal Anti-inflammatory Drug—Associated Azotemia in the Very Old

Author Affiliations

From the Program for the Analysis of Clinical Strategies, Beth Israel Hospital and Harvard Medical School, Boston, Mass (Drs Gurwitz, Avorn, and Ross-Degnan); the Hebrew Rehabilitation Center for the Aged, Boston (Drs Gurwitz and Lipsitz); the Department of Medicine, Beth Israel Hospital (Drs Gurwitz, Avorn, and Lipsitz); and the Division on Aging, Harvard Medical School (Drs Gurwitz, Avorn, and Lipsitz). Dr Gurwitz is a Merck Fellow in Geriatric Clinical Pharmacology.

From the Program for the Analysis of Clinical Strategies, Beth Israel Hospital and Harvard Medical School, Boston, Mass (Drs Gurwitz, Avorn, and Ross-Degnan); the Hebrew Rehabilitation Center for the Aged, Boston (Drs Gurwitz and Lipsitz); the Department of Medicine, Beth Israel Hospital (Drs Gurwitz, Avorn, and Lipsitz); and the Division on Aging, Harvard Medical School (Drs Gurwitz, Avorn, and Lipsitz). Dr Gurwitz is a Merck Fellow in Geriatric Clinical Pharmacology.

JAMA. 1990;264(4):471-475. doi:10.1001/jama.1990.03450040067033
Abstract

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 significant 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.

(JAMA. 1990;264:471-475)

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