TY - JOUR
T1 - Effects of Nonsteroidal Antiinflammatory Drugs on Renal Function in Patients With Renal Insufficiency and in Cirrhotics
AU - Brater, D. C.
AU - Anderson, S. A.
AU - Brown-Cartwright, D.
AU - Toto, R. D.
N1 - Funding Information:
From the Departments of Internal Medicine and Pharmacology, The University of Texas Health Science Center at Dallas. Supported by a grant from the NIH (RO]-AM27059) , an RCDA to Dr Brater (K04-AM00705), the GCRC (MO]RR00633), and grants from Ayerst Laboratories and Ives Laboratories. Address reprint requests to D. Craig Brater, MD, Division of Clinical Pharmacology, WOP 3]6, Wishard Memorial Hospital, ]00] W Tenth St, Indianapolis, IN 46202. © 1986 by the National Kidney Foundation, Inc. 0272-6386/86/0803-0012$03.00/0
PY - 1986
Y1 - 1986
N2 - We have assessed the effects of acute and chronic administration of etodolac, ketoprofen, and indomethacin on renal function in patients with mild to moderate chronic renal insufficiency (CRI). We studied 18 normal volunteers and 24 patients with CRI due to hypertension and/or diabetes mellitus with creatinine clearances between 19 and 83 mL/min/1.73 m2. Clearance studies were performed with the first dose of nonsteroidal anti! nflammatory drug (NSAID) to compare acute effects of the agent with a no-drug control. Subjects then received the NSAID for three to five days and, on the last day of study, underwent another clearance study to assess the effects of a single dose of NSAID superimposed on chronic dosing. With each dose of each NSAID, inulin and paraaminohippurate (PAH) clearances and fractional excretion of NA+ decreased. However, the baseline control collections after chronic dosing did not differ from the no-drug control periods. Hence, the decline in renal function with each dose is transient, and no overall adverse effect on renal function occurred with chronic dosing. In five patients with cirrhosis, we assessed the renal sparing effects of sulindac. After equilibration on a fixed sodium intake, they received a 200-mg dose of sulindac. In one patient, no adverse effect occurred; the remaining patients suffered declines in creatinine clearance of 29%, 87/0, 37%, and 37%, respectively. This effect was transient and returned to control values six to eight hours after sulindac administration. At the time of maximal depression of renal function, serum concentrations of sulindac sulfide were comparable to those in subjects with normal hepatic function. Hence, in susceptible patients, sulindac, like other NSAIDs, can adversely affect renal function.
AB - We have assessed the effects of acute and chronic administration of etodolac, ketoprofen, and indomethacin on renal function in patients with mild to moderate chronic renal insufficiency (CRI). We studied 18 normal volunteers and 24 patients with CRI due to hypertension and/or diabetes mellitus with creatinine clearances between 19 and 83 mL/min/1.73 m2. Clearance studies were performed with the first dose of nonsteroidal anti! nflammatory drug (NSAID) to compare acute effects of the agent with a no-drug control. Subjects then received the NSAID for three to five days and, on the last day of study, underwent another clearance study to assess the effects of a single dose of NSAID superimposed on chronic dosing. With each dose of each NSAID, inulin and paraaminohippurate (PAH) clearances and fractional excretion of NA+ decreased. However, the baseline control collections after chronic dosing did not differ from the no-drug control periods. Hence, the decline in renal function with each dose is transient, and no overall adverse effect on renal function occurred with chronic dosing. In five patients with cirrhosis, we assessed the renal sparing effects of sulindac. After equilibration on a fixed sodium intake, they received a 200-mg dose of sulindac. In one patient, no adverse effect occurred; the remaining patients suffered declines in creatinine clearance of 29%, 87/0, 37%, and 37%, respectively. This effect was transient and returned to control values six to eight hours after sulindac administration. At the time of maximal depression of renal function, serum concentrations of sulindac sulfide were comparable to those in subjects with normal hepatic function. Hence, in susceptible patients, sulindac, like other NSAIDs, can adversely affect renal function.
KW - Nonsteroidal anti inflammatory drugs
KW - acute renal failure
KW - cirrhosis
KW - prostaglandins
KW - renal function
KW - renal insufficiency
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U2 - 10.1016/S0272-6386(86)80110-X
DO - 10.1016/S0272-6386(86)80110-X
M3 - Article
C2 - 2947456
AN - SCOPUS:0022859502
SN - 0272-6386
VL - 8
SP - 351
EP - 355
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -