Use of prescribed NSAIDs remained low from 2005 to 2014 in the U.S. adult population. However, use of any prescribed NSAID was higher among all persons with CKD (8% for stages 1 & 2, and 9% for stages 3 & 4) than compared to those without CKD (5%). Specifically, during this time period, prescribed ibuprofen and naproxen appeared to increase among those with CKD stages 1 & 2, while it decreased in CKD stages 3 & 4.
Chart Explanation: Over the 10-year period, prevalence of prescribed NSAID use was less than 10% across the U.S. adult population. The percent of prescribed NSAID use was highest among individuals with CKD stages 3 & 4 compared to those with CKD stages 1 & 2 and those without CKD. More specifically, prescribed NSAID use in persons with CKD stages 3 & 4 was higher in 2011-2014 (9.2%) than in 2005-2010 (8.9%). Whereas in those with CKD stages 1 & 2, the prevalence was moderately less in 2011-2014 (7.6%) compared to 2005-2010 (7.9%).
Despite the low percentage of users on prescribed ibuprofen and naproxen, use increased from 3.1% in 2005-2010 to 3.7% in 2011-2014 among CKD stages 1 & 2. However, in CKD stages 3 & 4, use of prescribed ibuprofen and naproxen decreased from 2.7% in 2005-2010 to 2.3% in 2011-2014. Overall, prescribed ibuprofen and naproxen made up approximately half of the percent of all NSAID use among CKD stages 1 & 2, and about one-third of all NSAID use in CKD stages 3 & 4.
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely available both as over-the-counter and prescription pain relievers, but are relatively contra-indicated in persons with CKD due to their nephrotoxic effects. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014 NHANES. Interviewers examined medication use by asking survey participants if they had taken medications in the past 30 days for which they were prescribed. Medications were recorded from prescription bottles when the survey participant responded "yes." NSAIDs included ibuprofen, naproxen, sulindac, piroxicam, indomethacin, tolmetin, and diclofenac; aspirin and acetaminophen were considered relatively non-nephrotoxic and were excluded from analysis.
| Field | Data |
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| Description of Measure | Prevalence of prescribed NSAID use by CKD stage and year in the general adult population |
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| Data Source | NCHS |
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| Type of Data Source | Public |
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| Data Set | NHANES |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Noninstitutionalized U.S. residents aged 20+ years |
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| Numerator | Non-pregnant adult participants with data on albuminuria and creatinine who were prescribed NSAIDs |
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| Denominator | Non-pregnant adult participants with data on albuminuria and creatinine |
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| Definition of CKD | Stage 1, eGFR ≥ 90 ml/min/1.73 m² and presence of single albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and presence of single albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded |
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| Glomerular filtration rate | Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ x 0.993age x (1.018 if female) x (1.159 if NH Black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male |
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| Secondary (1) Variable | lbxscr: Serum creatinine |
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| Primary Indicator Method of Measurement | Questionnaire component of NHANES; participants were asked if they had taken a medication in the past month for which a prescription was required and respondents who answered “yes” were asked to provide the drug container to obtain names of the drugs |
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| Primary Data Source Indicator | NSAID medication utilization |
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| Secondary (1) Indicator Method of Measurement | Examination/Laboratory |
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| Secondary (2) Variable | rhd143, rhd141/rhd140, urxpreg: current pregnancy |
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| Secondary (2) Indicator Method of Measurement | Questionnaire (interviewer-administered) or exam (urine pregnancy status) |
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| Secondary (3) Variable | urxcua/urxucr: urinary proteins |
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| Secondary (3) Indicator Method of Measurement | Examination/laboratory |
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| Frequency of Measurement (Primary) | Once (cross-sectional) |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 2005–2014 |
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| Pending Data | 2015–2016 |
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| Additional Data Items of Interest | Stage of CKD, type of NSAID |
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| Limitations of Indicator | Prevalence of NSAID use does not include over-the-counter medication use, which may not reflect overall use of NSAIDs in the adult population; cross-sectional analysis |
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| Analytical Considerations | Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for 2005-2006; if standard error 30% or more of estimate, must report as "low precision" |
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