Bigotte Vieira Miguel, Neves João Sérgio, Baptista Rute Baeta, Leitão Lia, Viegas Dias Catarina, Vicente Ricardo, Nascimento Nilton, Leite Celina Costa, Rocha Isabel, Magriço Rita
Serviço de Nefrologia e Transplantação Renal. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal.
Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar Universitário de São João. Porto. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. Portugal.
Acta Med Port. 2019 Feb 28;32(2):119-125. doi: 10.20344/amp.10815.
Portugal presents the highest incidence of stage 5 chronic kidney disease in Europe. It is speculated that a high consumption of non-steroidal anti-inflammatory drugs (NSAIDS) may contribute to this high incidence. Our aim was to characterize the prescription of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus in Portugal.
We analyzed the national prescription database in triennium 2015 - 2017. In patients with diabetes mellitus, we evaluated the prescription of non-steroidal anti-inflammatory drugs according to age, gender and region of the patient and specialty of the prescribing physician. We evaluated the prescription of non-steroidal anti-inflammatory drugs in all patients with diabetes mellitus, in patients with presumed renal impairment, and in those with concomitant prescription of angiotensin converting enzyme inhibitors or angiotensin receptor antagonists.
We analyzed 23 320 620 prescriptions, corresponding to 610 157 adults, including 104 306 patients with diabetes mellitus. The most prescribed non-steroidal anti-inflammatory drugs were ibuprofen (20.1%), metamizole (14.7%), and diclofenac (11.4%). The prescription of non-steroidal anti-inflammatory drugs was higher in females, in patients aged 51 - 70 years and in the Alentejo region. Non-steroidal anti-inflammatory drugs were prescribed to 70.6% of patients with diabetes mellitus, from which 10.6% were prescribed ≥ 10 packages during the three years. Among patients with diabetes mellitus on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and with presumed reduction in kidney function, 69.3% were prescribed non-steroidal anti-inflammatory drugs and 11.5% were prescribed ≥ 10 packages during the three years.
The level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus is high. The concern of reducing non-steroidal anti-inflammatory drugs prescription to patients already on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and/or decreased renal function does not seem to exist.
In Portugal, the level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus should be reduced, particularly in the subgroups identified with higher prescription and with higher risk of progression to stage 5 chronic kidney disease.
葡萄牙是欧洲慢性肾脏病5期发病率最高的国家。据推测，非甾体抗炎药（NSAIDs）的高消费量可能导致了这一高发病率。我们的目的是描述葡萄牙糖尿病患者非甾体抗炎药的处方情况。
我们分析了2015 - 2017三年期的国家处方数据库。对于糖尿病患者，我们根据患者的年龄、性别、地区以及开处方医生的专业，评估了非甾体抗炎药的处方情况。我们评估了所有糖尿病患者、推测有肾功能损害的患者以及同时开具血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂的患者中非甾体抗炎药的处方情况。
我们分析了23320620张处方，对应610157名成年人，其中包括104306名糖尿病患者。处方量最多的非甾体抗炎药是布洛芬（20.1%）、安乃近（14.7%）和双氯芬酸（11.4%）。女性、51 - 70岁的患者以及阿连特茹地区的非甾体抗炎药处方量更高。70.6%的糖尿病患者开具了非甾体抗炎药，其中10.6%在三年期间开具了≥10包。在服用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂且推测肾功能下降的糖尿病患者中，69.3%开具了非甾体抗炎药，11.5%在三年期间开具了≥10包。
糖尿病患者的非甾体抗炎药处方水平较高。对于已经在服用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂和/或肾功能下降的患者，似乎不存在减少非甾体抗炎药处方的担忧。
在葡萄牙，应降低糖尿病患者的非甾体抗炎药处方水平，特别是在那些处方量较高且进展为慢性肾脏病5期风险较高的亚组中。
