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Jerry H. Gurwitz, MD; Jerry Avorn, MD; Dennis Ross-Degnan, ScD; Lewis A. Lipsitz, MD

JAMA. 1990;264(4):471-475.

Abstract
We conducted a prospective study in 114 elderly patients to determine the renal effects of short-term therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) in the very old. Study subjects were patients in a long-term care facility (mean age, 87 years) newly begun on a regimen of NSAID therapy. For the study group as a whole, the serum urea nitrogen level rose 1.7 mmol/L 5 to 7 days after initiation of therapy, with no significant changes in serum creatinine or potassium levels. In a comparison group of 45 patients not receiving NSAID therapy, no significant change in the serum urea nitrogen level was noted during a similar period. A subgroup of 15 patients (13%) experienced a greater than 50% increase in the serum urea nitrogen level during NSAID therapy, with a mean increase of 89% (8.6 mmol/L). A return to the baseline level occurred within 14 days after discontinuation of NSAID therapy. Two factors were significant predictors of a greater than 50% increase in the serum urea nitrogen level: concurrent loop diuretic therapy (odds ratio, 2.2) and high NSAID dose (odds ratio, 2.0). These findings suggest that reversible azotemia develops in a sizable proportion of the very old who are treated with short-term NSAID therapy.

(JAMA. 1990;264:471-475)

Author Affiliations
From the Program for the Analysis of Clinical Strategies, Beth Israel Hospital and Harvard Medical School, Boston, Mass (Drs Gurwitz, Avorn, and Ross-Degnan); the Hebrew Rehabilitation Center for the Aged, Boston (Drs Gurwitz and Lipsitz); the Department of Medicine, Beth Israel Hospital (Drs Gurwitz, Avorn, and Lipsitz); and the Division on Aging, Harvard Medical School (Drs Gurwitz, Avorn, and Lipsitz). Dr Gurwitz is a Merck Fellow in Geriatric Clinical Pharmacology.

Footnotes
Reprint requests to Program for the Analysis of Clinical Strategies, 333 Longwood Ave, Boston, MA 02115 (Dr Gurwitz).

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