Wang X et al. (2007) Iron status and the use of non-steroidal anti-inflammatory drugs in hemodialysis patients. Ther Apher Dial 11: 215–219
Wang et al. have investigated the relationship between the use of NSAIDs and iron status in 446 people receiving maintenance hemodialysis. NSAIDs are often used to treat bone or joint pain in this population. The authors conclude that the use of non-aspirin NSAIDs increases the risk of iron deficiency. By contrast, low-dose aspirin therapy does not have this effect.
During the 3 months preceding the index date, 95 patients were treated with aspirin, and 103 with non-aspirin NSAIDs. In comparison with those who received no anti-inflammatory therapy, patients who received non-aspirin NSAIDs—but not those who received aspirin—had significantly lower levels of serum iron (71.9 µg/dl [12.9 µmol/l] vs 60.6 µg/dl [10.8 µmol/l]; P = 0.002) and transferrin saturation (28.5% vs 24.6%; P = 0.011). These differences were observed despite a higher proportion of patients in the non-aspirin NSAID group having received iron preparations. The proportions of patients who received recombinant human erythropoietin or who had positive fecal blood tests did not differ between study groups. Logistic regression analysis revealed that non-aspirin NSAID therapy was associated with a twofold increased risk of requiring iron supplementation.
The authors suggest that, when compared with non-aspirin NSAIDS, the use of aspirin in hemodialysis patients could be associated with lower risks of occult bleeding and iron deficiency. They note, however, that in this study aspirin was used in low doses, as an anticoagulant but not as an analgesic.
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Non-aspirin NSAIDs increase the risk of iron deficiency in hemodialysis patients. Nat Rev Nephrol 3, 410 (2007). https://doi.org/10.1038/ncpneph0522