Русский
Glomerular filtration rate in patients with spondiloarthritis against the ackground of long-term therapy with NSAIDS - results of prospective observational study
DOI: https://dx.doi.org/10.18565/nephrology.2020.4.56-59
A.P. Rebrov, A.V. Aparkina
Saratov State Medical University named after V.I. Razumovsky; Saratov, Russia
Objective. Evaluation of the changes in glomerular filtration rate (GFR) in patients with spondyloarthritis (SpA) taking non-steroidal anti-inflammatory drugs (NSAIDs) for a long time.
Materials and methods. A prospective observational study included 82 patients with SpA who took NSAIDs for a long time. GFR was assessed at baseline and over time every 24–30 weeks. For the safety of treatment, a patient with a decrease in GFR of less than 90 ml/min/1.73 m2 was excluded from the study and transferred to another therapy. Patients took NSAIDs in two regimens: continuous regular intake of NSAIDs and continuous irregular intake of fixed or arbitrary doses of NSAIDs (continuous intermittent intake).
Results. The mean GFR for the entire group of patients was 104.8 [94.6; 118.2] ml/min/1.73 m2. After 6–12 months of follow-up, the mean GFR in 68 patients was 95.5 [85.5; 110.0] ml/min/1.73 m2 (P = 0.032 relative to the baseline mean GFR in these 68 patients), 15 patients showed a decrease in GFR of less than 90 ml/min/1.73 m2. These patients were excluded from the study. After 12-18 months of follow-up, the remaining 53 patients had an mean GFR of 101.0 [86.0; 111.0] ml/min/1.73 m2 (P≥0.05 relative to the previous level), 18 patients showed a decrease in GFR less than 90 ml/min/1.73 m2. After 18-24 months of follow-up, the mean GFR was 102.0 [91.0; 119.0] ml/min/1.73 m2 (P≥0.05); the decrease in GFR less than 90 ml/min/1.73 m2 was not identified. Further, only 22 patients took part in the study, their mean GFR after 24-30 months of follow-up was 106.0 [106.0; 118.5] ml/min/1.73 m2 (P≥0.05 relative to baseline level). The features of GFR changes with different NSAID intake were revealed.
Conclusion. Observational study revealed that in patients with SpA with initially unimpaired GFR, taking NSAIDs for a long time (at least 2 years), GFR may not change significantly and remain normal. Against the background of long-term therapy with NSAIDs, some patients with SpA may have a decrease in GFR of less than ml/min/1.73 m2, but no severe kidney injury was noted. With dynamic follow-up, it was found that in patients taking NSAIDs in an intermittent mode, a decrease in GFR occurs more often than in patients taking NSAIDs regularly.
Materials and methods. A prospective observational study included 82 patients with SpA who took NSAIDs for a long time. GFR was assessed at baseline and over time every 24–30 weeks. For the safety of treatment, a patient with a decrease in GFR of less than 90 ml/min/1.73 m2 was excluded from the study and transferred to another therapy. Patients took NSAIDs in two regimens: continuous regular intake of NSAIDs and continuous irregular intake of fixed or arbitrary doses of NSAIDs (continuous intermittent intake).
Results. The mean GFR for the entire group of patients was 104.8 [94.6; 118.2] ml/min/1.73 m2. After 6–12 months of follow-up, the mean GFR in 68 patients was 95.5 [85.5; 110.0] ml/min/1.73 m2 (P = 0.032 relative to the baseline mean GFR in these 68 patients), 15 patients showed a decrease in GFR of less than 90 ml/min/1.73 m2. These patients were excluded from the study. After 12-18 months of follow-up, the remaining 53 patients had an mean GFR of 101.0 [86.0; 111.0] ml/min/1.73 m2 (P≥0.05 relative to the previous level), 18 patients showed a decrease in GFR less than 90 ml/min/1.73 m2. After 18-24 months of follow-up, the mean GFR was 102.0 [91.0; 119.0] ml/min/1.73 m2 (P≥0.05); the decrease in GFR less than 90 ml/min/1.73 m2 was not identified. Further, only 22 patients took part in the study, their mean GFR after 24-30 months of follow-up was 106.0 [106.0; 118.5] ml/min/1.73 m2 (P≥0.05 relative to baseline level). The features of GFR changes with different NSAID intake were revealed.
Conclusion. Observational study revealed that in patients with SpA with initially unimpaired GFR, taking NSAIDs for a long time (at least 2 years), GFR may not change significantly and remain normal. Against the background of long-term therapy with NSAIDs, some patients with SpA may have a decrease in GFR of less than ml/min/1.73 m2, but no severe kidney injury was noted. With dynamic follow-up, it was found that in patients taking NSAIDs in an intermittent mode, a decrease in GFR occurs more often than in patients taking NSAIDs regularly.
Keywords: axial spondyloarthritis, non-steroidal anti-inflammatory drugs, safety of NSAIDs, renal safety
About the Autors
Andrey P. Rebrov – Dr.Sci. (Med,), Professor, Head of the Department of Hospital Therapy, Faculty of General Medicine, Saratov State Medical University named after
V.I. Razumovsky Saratov, Russia. E-mail: andreyrebrov@yandex.ru. ORCID: 0000-0002-3463-7734
Alena V. Aparkina – Cand. Sci. (Med.), Teaching Assistant at the Department of Hospital Therapy, Faculty of General Medicine, Saratov State Medical University named after V.I. Razumovsky; Saratov, Russia. E-mail: alena437539@yandex.ru
