Analgesics use and ESRD in younger age: a case-control study

<p>Abstract</p> <p>Background</p> <p>An ad hoc peer-review committee was jointly appointed by Drug Authorities and Industry in Germany, Austria and Switzerland in 1999/2000 to review the evidence for a causal relation between phenacetin-free analgesics and nephropathy. The committee found the evidence as inconclusive and requested a new case-control study of adequate design.</p> <p>Methods</p> <p>We performed a population-based case-control study with incident cases of end-stage renal disease (ESRD) under the age of 50 years and four age and sex-matched neighborhood controls in 170 dialysis centers (153 in Germany, and 17 in Austria) from January 1, 2001 to December 31, 2004. Data on lifetime medical history, risk factors, treatment, job exposure and intake of analgesics were obtained in a standardized face-to-face interview using memory aids to enhance accuracy. Study design, study performance, analysis plan, and study report were approved by an independent international advisory committee and by the Drug Authorities involved. Unconditional logistic regression analyses were performed.</p> <p>Results</p> <p>The analysis included 907 cases and 3,622 controls who had never used phenacetin-containing analgesics in their lifetime. The use of high cumulative lifetime dose (3^rdtertile) of analgesics in the period up to five years before dialysis was not associated with later ESRD. Adjusted odds ratios with 95% confidence intervals were 0.8 (0.7 – 1.0) and 1.0 (0.8 – 1.3) for ever- compared with no or low use and high use compared with low use, respectively. The same results were found for all analgesics and for mono-, and combination preparations with and without caffeine. No increased risk was shown in analyses stratifying for dose and duration. Dose-response analyses showed that analgesic use was not associated with an increased risk for ESRD up to 3.5 kg cumulative lifetime dose (98 % of the cases with ESRD). While the large subgroup of users with a lifetime dose up to 0.5 kg (278 cases and 1365 controls) showed a significantly decreased risk, a tiny subgroup of extreme users with over 3.5 kg lifetime use (19 cases and 11 controls) showed a significant risk increase. The detailed evaluation of 22 cases and 19 controls with over 2.5 kg lifetime use recommended by the regulatory advisors showed an impressive excess of other conditions than analgesics triggering the evolution of ESRD in cases compared with controls.</p> <p>Conclusion</p> <p>We found no clinically meaningful evidence for an increased risk of ESRD associated with use of phenacetin-free analgesics in single or combined formulation. The apparent risk increase shown in a small subgroup with extreme lifetime dose of analgesics is most likely an indirect, non-causal association. This hypothesis, however, cannot be confirmed or refuted within our case-control study. Overall, our results lend support to the mounting evidence that phenacetin-free analgesics do not induce ESRD and that the notion of "analgesic nephropathy" needs to be re-evaluated.</p

Risk factors for the development of chronic renal failure : Epidemiological studies on the role of analgesic use, occupational exposures and socioeconomic background

Chronic renal failure is a severe condition that reduces life expectancy and typically progresses to end-stage renal disease and a need for renal replacement therapy. In a large proportion of cases, chronic renal failure evolves from known renal or systemic diseases, but in some cases the pathogenesis remains unknown. The aim of this thesis was to investigate whether the use of paracetamol and aspirin, occupation and workplace exposures, and socioeconomic status affect the development of chronic renal failure. We conducted a nation-wide population-based case-control study in Sweden. All 5.3 million native-born residents aged 18 to 74 years, living in the country during the period from May, 1996, through May, 1998, formed the study base. Personal interviews were performed with 926 patients with incident pre-uraemic chronic renal failure and 928 randomly selected control subjects. Regular use of either paracetamol or aspirin in the absence of the other was associated with a significant 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, and were increased for most disease-specific types of chronic renal failure. The associations were only slightly attenuated when the recent use of analgesics, which could have occurred in response to antecedents of renal disease, was disregarded. Our results are consistent with the existence of exacerbating effects of paracetamol and aspirin on chronic renal failure. Low socio-economic status was associated with an increased risk of chronic renal failure. In families with unskilled workers only, the risk of chronic renal failure was increased by 110% and 60% among women and men, respectively, relative to subjects living in families in which at least one member was a professional. Subjects with 9 years or less of schooling had a 30% higher risk compared with those with a university education. The excess risk was of similar magnitude regardless of underlying renal disease. The moderate excess was not explained by age, sex, body mass index, smoking, alcohol or analgesic intake. Thus, socioeconomic status appeared to be an independent risk indicator for chronic renal failure in Sweden. Our results did not support the hypothesis of an adverse effect of organic solvents on chronic renal failure development, in general. The overall risk for chronic renal failure among subjects ever exposed to organic solvents was virtually identical to that among never-exposed (odds ratio, 1.01; 95% Cl, 0.81-1.25). No dose-response relationships were observed for lifetime cumulative solvent exposure, average dose, or exposure frequency or duration. The absence of association pertained to all subgroups of chronic renal failure. Detrimental effects from subclasses of solvents or on specific renal diseases cannot be ruled out. Except for organic solvents and exhaust fumes, which were unrelated to risk of chronic renal failure, the exposure prevalence were low to the workplace exposure agents implicated in the literature. Silica and cadmium were associated with 39% (95% Cl, 0-94%) and 26% (95% Cl, -55-67%) excess risks, respectively, but apart from this, no striking excesses were found. There was an up to 2-fold variation in risk for chronic renal failure across occupational groups. This significant heterogeneity (P=0.001) in chronic renal failure risk among occupational groups could not be explained by studied lifestyle factors or workplace exposures

Increased risk of end-stage renal disease in individuals with coeliac disease

Objective The prevalence of end-stage renal disease (ESRD) is increasing worldwide. Although increased levels of coeliac disease (CD) autoantibodies are often seen in renal disease, the importance of biopsy-verified CD for the risk of future ESRD is unclear. The aim of this study was therefore to investigate the risk of future ESRD in individuals with CD. Methods This was a population-based prospective cohort study. 29 050 individuals with CD (Marsh III) were identified through small-intestinal biopsy reports obtained between July 1969 and February 2008 in Sweden's 28 pathology departments. ESRD was defined as the need for renal dialysis or renal transplant in accordance with the international classification of disease and procedure codes in Swedish patient registers. Using Cox regression, the risk of ESRD in individuals with CD compared with age- and sex-matched reference individuals was estimated. Results During follow-up, 90 individuals with CD developed ESRD (expected count 31). This corresponded to a HR for ESRD of 2.87 (95% CI 2.22 to 3.71, p<0.001). Adjusting for diabetes mellitus had only a marginal effect on the risk estimate (HR 2.52, 95% CI 1.92 to 3.31). Excluding individuals with any urinary/renal disorder before study entry, the HR for ESRD in CD was 2.47 (95% CI 1.80 to 3.40). When restricting the outcome measure to ESRD confirmed by independent data from the Swedish Renal Registry (SRR), the risk estimate increased to 3.20 (95% CI 2.39 to 4.28). Conclusion This study indicates that individuals with biopsy-verified CD suffer increased risk of subsequent ESRD

The financing and organization of medical care for patients with end-stage renal disease in Sweden

End-stage kidney disease, Health care costs, Economics, Renal replacement therapy, Dialysis, Reimbursement, Sweden, I10, I11, I12, I18,

Periodontitis, assessed using periodontal treatment as a surrogate marker, has no association with a first myocardial infarction in a Swedish population

Background: Periodontitis is suggested to be associated with a risk of cardiovascular events. Using periodontal treatment recorded in Swedish national registries as a surrogate marker, we aimed to investigate whether periodontitis was associated with a first myocardial infarction. Methods: This nationwide case-control study, with data from national registries, involved 51,880 individuals with a first myocardial infarction in 2011 to 2013 (index date) and 246,978 controls matched 5:1 for age, gender, and geographic area. Periodontal treatment in the 3 years preceding the index date was classified as (1) no dental treatment, (2) no periodontal treatment, (3) one or more supragingival curettages, or (4) one or more treatments with scaling/root planing and/or periodontal surgery. Annual frequencies of treatment with scaling/root planing and/or periodontal surgery were also calculated. In all analyses, conditional logistic regression analyses estimated ORs for myocardial infarction with 95% CIs, adjusted for matched variables, income, education, and diabetes. Results: Although fewer cases than controls received treatment with scaling/root planing and/or periodontal surgery (19.2% versus 19.8%, P < 0.001), annual frequencies for cases were higher. We found no association of scaling/root planing and/or periodontal surgery with a first myocardial infarction (OR = 1.02; 95% CI: 1.00, 1.05). We did observe a non-significant trend, however, between risk of a first myocardial infarction and a high frequency of scaling/root planing and/or periodontal surgery (OR 1.14; 95% CI: 1.00, 1.29). Conclusion: In the contemporary Swedish nationwide setting, no association between a first myocardial infarction and periodontitis, assessed as periodontal treatment, was found

Consumption of Dental Treatment in Patients with Inflammatory Bowel Disease, a Register Study

<div><p>Objective</p><p>The aim of this study was to compare the consumption of dental treatment among patients with Crohn´s disease (CD) or ulcerative colitis (UC) compared to age and gender matched control groups.</p><p>Design</p><p>The study group comprised 2085 patients with CD and 3161 with UC from the Uppsala-Örebro region and from the Stockholm region. The patients in the cohort were diagnosed between 1960 and 1989. Patients up to 70 years of age were included in the study. The two patients groups were compared to age- and gender-matched, randomly selected control groups from the same geographic area comprising a corresponding number of participants.</p><p>Results</p><p>CD patients had significantly higher total number of procedures registered (p < 0.000). The difference was most pronounced for removable dentures (+65%), fillings in front teeth (+52%) and endodontic treatment (+46%) when Crohn’s patients were compared to controls (p<0.001). The corresponding figures for UC patients were also a significantly higher total number of procedures (p < 0.005), more clinical examinations (p<0.000), fillings in canines and incisors (p < 0.001) and fillings in bicuspids and molars (p < 0.000).</p><p>Conclusion</p><p>This study demonstrate that CD and UC individuals use more dental treatment compared to an age-gender matched control group, and more caries-related treatments. The difference was most pronounced for restorative treatment in patients with Crohn’s.</p></div

Does smoking cessation affect postoperative healing following oral surgery among smokers? - a systematic review.

BACKGROUND: It is well documented that smokers suffer increased risk of postoperative complications after medical surgery, for example delayed healing and increased risk of infection. It is also known that preoperative smoking cessation can reduce the risk of these complications. Because of this there are guidelines regarding preoperative smoking cessation in non-oral medical surgery. There are however no specific guidelines regarding oral surgical procedures, such as surgical extractions, dentoalveolar surgery, periodontal surgery, or dental implantation. Nevertheless, it is common that dentists and oral surgeons recommend smoking cessation pre to oral surgical procedures. The aim with this systematic review was to see if there are any evidence in the literature, supporting preoperative smoking cessation in oral surgical procedures. METHODS: A systematic search of the electronic databases PubMed, Scopus, Web of Science, and Cochrane was conducted to identify studies addressing the effect of preoperative smoking cessation in oral surgical procedures. Included publications were subjected to preidentified inclusion criterion. Six examiners performed the eligibility and quality assessment of relevant studies. Risk of bias was assessed using ROBINS-I and RoB 2. Certainty assessment was carried out using GRADE. RESULTS: The initial search resulted in 2255 records, and after removal of 148 duplicates, 16 articles met an acceptable level of relevance. These were read in full text, whereof 12 articles were excluded, due to different intervention, outcome, or study design than stated in the review protocol. One study remained with moderate risk of bias and three were excluded due to high risk of bias. CONCLUSION: This systematic review could not determine the effect of smoking cessation pre to oral surgical procedures, in smokers. This indicates lack of knowledge in the effects of smoking cessation. We also conclude a lack of knowledge in how to design smoking cessation in the most effective way

Demografic data for 3161 patients with Crohn’s disease and 2085 patients with Ulcerative colitis, and their gender and age matched controls.

<p>Demografic data for 3161 patients with Crohn’s disease and 2085 patients with Ulcerative colitis, and their gender and age matched controls.</p

Acetaminophen, aspirin and progression of advanced chronic kidney disease

Background. Although many studies have investigated the possible association between analgesic use (acetaminophen and aspirin) and the development of chronic kidney disease (CKD), the effect of analgesics on the progression of established CKD of any cause has not yet been investigated. Methods. In this population-based Swedish cohort study, we investigated the decline over 5-7 years in estimated glomerular filtration rate (eGFR) among 801 patients with incident, advanced CKD (serum creatinine > 3.4 mg/dL for men, > 2.8 mg/dL for women for the first time) and with different analgesic exposures. Lifetime analgesic use and current regular use were ascertained through in-person interviews at inclusion while data on analgesic use during the follow-up was abstracted from the medical records at the end of the study period. A linear regression slope, based on their eGFR values during the follow-up, provided a summary of within-individual change. In the final multivariate analyses, a linear mixed effects model was implemented to assess the relation of analgesic use and change in eGFR over time. Results. The progression rate for regular users of acetaminophen was slower than that for non-regular users (regular users progressed 0.93 mL/min/1.73 m(2) per year slower than non-regular users; 95% CI 0.03, 1.8). For regular users of aspirin, the progression rate was significantly slower than that for non-regular users (regular users progressed 0.80 mL/min/1.73 m(2) per year slower than non-regular users; 95% CI 0.1, 1.5). Different levels of lifetime cumulative dose of acetaminophen and aspirin did not significantly affect the progression rate. Conclusion. We suggest that single substance acetaminophen and aspirin may be safe to use by patients with diagnosed advanced CKD stage 4-5 without an adverse effect on the progression rate of the disease