Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
- Analgesic intake should be discontinued in patients with analgesic nephropathy. (Level II– III evidence)
- Non-selective cyclo-oxygenase-1 (COX-1) and COX-2 inhibitors (with the specific exception of low dose aspirin) should be avoided, where possible, in patients with hypertension, as their use is associated with loss of blood pressure (BP) control and reduction in efficacy of antihypertensive drug therapy. (Level I evidence)
- Analgesic and anti-inflammatory therapy form an important component of the management of a variety of chronic degenerative diseases. (Level I evidence) The beneficial effects of these agents should be balanced against the risk of progressive renal damage and hypertension associated with their chronic and habitual use.
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
- Continued analgesic intake is associated with an increased faster rate of decline of renal function and increased risk of end-stage kidney disease (ESKD) in patients with analgesic nephropathy. (Level II-III evidence; large prospective cohort studies; clinically relevant outcomes; consistent strong effects).
- Cessation of analgesic use has been associated with retardation of kidney failure progression. (Level II-III evidence; several retrospective cohort studies; clinically relevant outcomes; variable effects).
- The use of non-selective COX-1 and COX-2 inhibitors is associated with loss of BP control and reduction in efficacy of antihypertensive drug therapy. (Level I-II evidence; large meta-analyses and randomized control trials (RCTs), clinically relevant outcomes; consistent strong effects)
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test
