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Comment & Response
April 2019

Association of NSAID Use and Renal Complications—Reply

Author Affiliations
  • 1Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
  • 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • 3Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 4Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2019;179(4):587. doi:10.1001/jamainternmed.2018.8681

In Reply We would like to thank Silver and colleagues for their thoughtful letter regarding our study.1 The authors raise important considerations regarding the safety of treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with heart failure or chronic kidney disease (CKD), because the high-risk cohort we identified were mainly patients with hypertension. We defined high-risk in this instance using the American Society of Nephrology’s Choosing Wisely recommendation, which states, “avoid [NSAIDs] in individuals with hypertension or heart failure or CKD of all causes, including diabetes.”2 Furthermore, the primary objective of the study was to estimate the frequency of NSAID prescription among high-risk patients seen in a primary care practice, which generally sees lower-risk patients than those in specialty care such as nephrology or cardiology practices. It is not surprising that the majority of primary care patients seen had hypertension as the main inclusion criterion.

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