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Open Access Study protocol

Case-control study on analgesics and nephropathy (SAN): protocol

Lothar AJ Heinemann1*, Edeltraut Garbe2, Michael Lewis3, Fokko van der Woude4 and Helmut Graf5

Author Affiliations

1 Centre for Epidemiology & Health Research Berlin, Invalidenstr. 115, 10115 Berlin, Germany

2 Institute for Clinical Pharmacology, Charité-University Medicine Berlin, Schumannstr. 20–21, 10117 Berlin, Germany

3 EPES Epidemiology, Pharmacoepidemiology and Systems Research GmbH, Wulfstr. 8, 12165 Berlin, Germany

4 Nephrology, 5. Med. Klinik, Klinikum Heidelberg-Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany

5 Neprologie, Krankenanstalt der Stadt Wien, Rudolfstifting, 3. Med. Abteilung, Juchgasse 25, 1030 Wien, Austria

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BMC Nephrology 2005, 6:9  doi:10.1186/1471-2369-6-9

Published: 8 August 2005



The association between intake of non-phenacetin-containing analgesics and the occurrence of chronic renal failure is still controversially discussed. A new epidemiologic study was planned and conducted in Germany and Austria.


The objective of the international, multicenter case-control study was to evaluate the association between end-stage renal disease (ESRD) and use of non-phenacetin-containing analgesics with particular emphasis on combined formulations. A targeted sample of 1000 new (incident) dialysis patients, aged less than 50 years, was planned to recruit between January 1, 2001 and December 31, 2004. The age limit was chosen to avoid contamination of the study population with phenacetin-containing analgesics to the extent possible. Four control subjects per ESRD case, matched by age, sex, and region were selected from the population living in the region the case came from.

Lifetime exposure to analgesics and potential renal risk factors were recorded in a single face-to-face interview. A set of aids was introduced to reinforce the memory of study participants.

A standardized, pre-tested interview questionnaire (participants), a medical documentation sheet (physicians in dialysis centres), a logbook for all activities (dialysis centres) were used to collect the necessary data.

Quality management consisted of the standardized procedures, (re-) training and supervision of interviewers, regular checks of all incoming data for completeness and plausibility.

The study is scientifically independent and governed by a international Scientific Advisory Committee that bridged the gap between the sponsoring companies and the investigators. Also other advisory groups assisted the managing committee of the study. All relevant German and Austrian nephrological associations supported the study, and the study design was carefully reviewed and approved by the Kidney Foundation of Germany.


The study is expected to answer the main research question by end 2005. There is however a high potential for various biases that we tried to address with adequate measure. One limitation however cannot be overcome: The methodologically needed age-limitation of the study will make it not easy to generalize the results to age groups over 50 years. It might be suggested to repeat the study for persons over 50 years in 10 years when contamination with phenacetin use early in life is likely to be outgrown.