만성 신장병 환자에서 금기 비스테로이드성항염증제의 처방 현황

Real World Prescription of Nonsteroidal Anti-inflammatory Drugs Contraindicated in Patients with Chronic Kidney Disease

A retrospective cross-sectional study was conducted to investigate prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) contraindicated in patients with chronic kidney disease (CKD) using the Health Insurance Review and Assessment Service (HIRA) claims data 2023. Contraindicated NSAID prescriptions were identified using the generic name codes provided by HIRA, and contraindications were determined based on the primary and secondary diagnosis codes recorded immediately prior to the NSAID prescription. In 2023, 78,812 of 435,712 CKD patients (18.1%) received a total of 329,507 prescriptions of contraindicated NSAIDs. Among the 356,646 contraindicated NSAID prescription instances identified from the 329,507 prescriptions, 88.8% were non-selective NSAIDs (tNSAIDs) and 11.2% were coxibs. The majority of the contraindicated NSAIDs were prescribed in primary healthcare facilities (66.2%), followed by secondary (29.6%) and tertiary (4.2%) healthcare settings. Most of tNSAIDs (79.1%) and coxibs (76.9%) were prescribed to patients with estimated CKD stage 5, and the difference between two groups was negligible (absolute standardized difference [aSD] 0.053). Most tNSAIDs (88.1%) and coxibs (86.1%) were prescribed to outpatients (aSD 0.061). Among outpatient oral NSAIDs, 85.3% of tNSAID were prescribed for 7 days, while 23.1 and 10.7% of coxibs were prescribed for 16-30 days and for >30 days, respectively. Among the prescriptions for contraindicated NSAIDs, only 66.4% of tNSAID prescriptions and 62.3% of coxib prescriptions included indications for NSAID use in the primary or secondary disease code fields. Before prescribing NSAIDs to patients with CKD, it is important to carefully weigh the benefits of NSAID use against the potential risk of nephrotoxicity.