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NSAIDS IN PATIENTS WITH RHEUMATIC DISEASES AND CHRONIC KIDNEY DISEASE: TO PRESCRIBE OR NOT TO PRESCRIBE?
Summary. The management of pain in patients with rheumatic diseases and chronic kidney disease (CKD) is challenging because of caution of nonsteroidal anti-inflammatory drugs (NSAIDs) use in this group of patients. The purpose of this review was to present possible approaches of NSAIDs use in rheumatological patients with CKD and selection of optimal NSAID. Methods. A review of the literature and give an information on the possible risks of using various NSAIDs. Results and discussion. The risks of NSAID use in different categories of CKD patients, possible side effects, as well as the influence of risk factors on renal adverse reactions development associated with NSAIDs use are considered. Data on the risk of nephrotoxicity for NSAIDs use, as well as recommendations for their use in certain categories of patients. Attention is drawn to diclofenac as a representative of «traditional» NSAIDs, which has one of the lowest risks of nephrotoxicity for this group of drugs, as well as nimesulide — a selective COX-2 inhibitor, which has demonstrated a favorable renal safety profile, further ketoprofen and individual coxibs analysis is needed. Conclusions. NSAIDs can be used in some categories of rheumatological patients with CKD, considering the individual risk of nephrotoxicity and treatment duration, as well as under close medical supervision.
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