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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Bouck Z, Ivers NM, Bhatia RS. Association of NSAID Use and Renal Complications—Reply. JAMA Intern Med. 2019;179(4):587. doi:10.1001/jamainternmed.2018.8681
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