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Previous Volume 345:1801-1808 December 20, 2001 Number 25 Next

	Full Text PDF Editorial by Crofford, L. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Several epidemiologic studies have demonstrated an association between heavy consumption of nonnarcotic analgesics and the occurrence of chronic renal failure, but it is unclear which is the cause and which is the effect.

Methods In a nationwide, population-based, case–control study of early-stage chronic renal failure in Sweden, face-to-face interviews were conducted with 926 patients with newly diagnosed renal failure and 998 control subjects, of whom 918 and 980, respectively, had complete data. We used logistic-regression models to estimate the relative risks of disease-specific types of chronic renal failure associated with the use of various analgesics.

Results Aspirin and acetaminophen were used regularly by 37 percent and 25 percent, respectively, of the patients with renal failure and by 19 percent and 12 percent, respectively, of the controls. Regular use of either drug in the absence of the other was associated with an increase by a factor of 2.5 in the risk of chronic renal failure from any cause. The relative risks rose with increasing cumulative lifetime doses, rose more consistently with acetaminophen use than with aspirin use, and were increased for most disease-specific types of chronic renal failure. When we disregarded the recent use of analgesics, which could have occurred in response to antecedents of renal disease, the associations were only slightly attenuated.

Conclusions Our results are consistent with the existence of exacerbating effects of acetaminophen and aspirin on chronic renal failure. However, we cannot rule out the possibility of bias due to the triggering of analgesic consumption by predisposing conditions.

Source Information

From the Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden (C.M.F., E.E., P.L., P.W.D., C.-G.E., O.N.); the Department of Renal Medicine, Huddinge University Hospital, Huddinge, Sweden (C.M.F., C.-G.E.); the International Epidemiology Institute, Rockville, Md., and the Department of Medicine, Vanderbilt University Medical Center, Nashville (J.P.F., L.B.S., L.L., W.J.B., J.K.M.); and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (M.M.Z.).

Address reprint requests to Dr. Fored at the Karolinska Institute, Department of Medical Epidemiology, Box 281, SE-171 77 Stockholm, Sweden, or at michael.fored{at}mep.ki.se.

Full Text of this Article

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N Engl J Med 2002; 346:1588-1589, May 16, 2002. Correspondence

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