While randomised clinical trials remain the gold-standard for examining drug-effects, there are limitations to the evidence they provide. For example, studies are usually too small or too short to detect rare and long-term adverse effects. This is particularly true for kidney-related outcomes where many trials were underpowered to detect outcomes of interest such as end-stage renal disease, too historic to collect data on newly-defined entities such as acute kidney injury or simply excluded patients with chronic kidney disease. In addition, disproportionate recruitment of Caucasian men in mid- to older-life limits the evidence base for understanding risk of adverse-effects in other population groups such as women, the elderly and people of non-Caucasian ethnicity. Determining these outcomes requires long-term surveillance of population databases, usually anonymised health care records, once a drug is in routine use.

In this talk I will discuss recent work from our group where we have used routinely collected renal function measurements from primary care to precisely examine kidney-related and other adverse effects. I will discuss some of the difficulties of this approach as well as the potential it offers to understand better the balance between risks and benefits of many drugs in common use.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.7865