Impact of non-steroidal antiinflammatory drugs on renal magnesium transportation in patients with osteoarthritis without signs of chronic kidney disease
Abstract. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in patients with osteoarthritis (OA), but nephrotoxicity is a common side effect of their use. Safety estimation of NSAIDs is based on an analysis of drug-related complications in real clinical practice and monitoring of renal function.Bulkina V.Yu., Voronina N.V., Lemeshchenko O.V., Zhmerenetsky K.V.
The aim: to determine the effect of NSAIDs nimesulide, celecoxib, and etoricoxib on renal magnesium transportation in patients with OA without signs of chronic kidney disease (CKD).
Material and methods. The study included 126 patients with Kellgren – Lawrence stages 2–3 knee OA without signs of CKD who required NSAIDs prescription. Participants were randomized into three groups: Group 1 (n = 48) received nimesulide (6000 mg/monthly dose); Group 2 (n = 40) received celecoxib (6000 mg/monthly dose); Group 3 (n = 38) received etoricoxib (2700 mg/monthly dose). Renal magnesium transportation was assessed by measuring serum and 24-hour urine Mg2+ concentrations, calculating magnesium clearance, and comparing it with the estimated glomerular filtration rate before and after NSAIDs administration.
Results. The study showed that, during a course of treatment for OA exacerbations by selective cyclooxygenase-2 inhibitors (nimesulide, celecoxib, and etoricoxib), patients without signs of CKD significantly reduced the estimated glomerular filtration rate by 10–12%, increased urinary magnesium excretion by 9–11%, and increased renal clearance by 20–25%, without a statistically significant change in serum Mg2+ concentrations, regardless of the type of drug used (p >0.05).
Conclusion. In our opinion, for the purpose to ensure rational and safe NSAIDs therapy, monitoring for the potential development of magnesium deficiency is essential when increasing the duration of treatment with these drugs.
Keywords
osteoarthritis
nonsteroidal anti-inflammatory drugs
nimesulide
celecoxib
etoricoxib
renal magnesium transportation
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About the Authors
Veronika Yu. Bulkina, MD, deputy head of Medical Department, 301st Military Clinical Hospital of the Ministry of Defence of the Russian Federation, postgraduate student of the Department of internal medicine, geriatrics, and instrumental diagnostics, Far Eastern State Medical University of the Ministry of Healthcare of Russia. Address: 680028, Khabarovsk, 1 Serysheva St.E-mail: rona.76@mail.ru
ORCID: http://orcid.org/0009-0005-0253-3075
Natalya V. Voronina, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine, geriatrics, and instrumental diagnostics, Far Eastern State Medical University of the Ministry of Healthcare of Russia. Address: 680000, Khabarovsk, 35 Muravyova-Amurskogo St.
E-mail: mdvoronina@yandex.ru
ORCID: http://orcid.org/0000-0002-3284-8108. Scopus ID: 57189009267. eLibrary SPIN-code: 9410-7664
Olga V. Lemeshchenko, MD, PhD (Medicine), dean of the Faculty of medical residency with the career and employment center, associate professor of the Department of public health and healthcare organization, Far Eastern State Medical University of the Ministry of Healthcare of Russia. Address: 680000, Khabarovsk, 35 Muravyova-Amurskogo St.
E-mail: lem_aa@mail.ru
ORCID: http://orcid.org/0000-0002-1051-0958. Scopus ID: 57204728578. eLibrary SPIN-code: 1502-1216
Konstantin V. Zhmerenetsky, MD, Dr. Sci. (Medicine), associate professor, corresponding member of RAS, chief therapist of the Ministry of Healthcare of Khabarovsk region, rector of the Far Eastern State Medical University of the Ministry of Healthcare of Russia. Address: 680000, Khabarovsk, 35 Muravyova-Amurskogo St.
Е-mail: zhmerenetsky@list.ru
ORCID: http://orcid.org/0000-0002-6790-3146. Scopus ID 57205453442. eLibrary SPIN-код: 8339-6596
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