Indicator Details: Use of Prescribed NSAIDsa
Data Sources
 
Stratification and Year Choices:

  Source
  • NHANES

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Footnotes:
a Any NSAID included all listed NSAIDs found in the medication usage questionnaire with the exclusion of aspirin and acetaminophen.




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.
FieldData
Description of MeasurePrevalence of prescribed NSAID use by CKD stage and year in the general adult population
Data SourceNCHS
Type of Data SourcePublic
Data SetNHANES
Health Care System DataNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. residents aged 20+ years
NumeratorNon-pregnant adult participants with data on albuminuria and creatinine who were prescribed NSAIDs
DenominatorNon-pregnant adult participants with data on albuminuria and creatinine
Definition of CKDStage 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
Glomerular filtration rateEstimated 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
Secondary (1) Variablelbxscr: Serum creatinine
Primary Indicator Method of MeasurementQuestionnaire 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
Primary Data Source IndicatorNSAID medication utilization
Secondary (1) Indicator Method of MeasurementExamination/Laboratory
Secondary (2) Variablerhd143, rhd141/rhd140, urxpreg: current pregnancy
Secondary (2) Indicator Method of MeasurementQuestionnaire (interviewer-administered) or exam (urine pregnancy status)
Secondary (3) Variableurxcua/urxucr: urinary proteins
Secondary (3) Indicator Method of MeasurementExamination/laboratory
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available2005–2014
Pending Data2015–2016
Additional Data Items of InterestStage of CKD, type of NSAID
Limitations of IndicatorPrevalence 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
Analytical ConsiderationsAppropriate 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"
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd