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Evidence summaries

Nsaids and Risk of Acute Renal Failure

The use of NSAIDs appears to increase the risk of acute renal failure. The risk appears to be slightly higher in the elderly and those with chronic kidney disease. Level of evidence: "B"

A systematic review and meta-analysis 2 of population-based observational studies assessed the risk of acute kidney injury (AKI) associated with NSAIDs in community-dwelling adults and those with pre-existing chronic kidney disease (CKD). In the general population 126 405 subjects were exposeured to NSAIDs and 1482 758 were not (10 trials), the pooled odds ratio (OR) of AKI for current NSAID exposure was 1.73 (95% CI 1.44 to 2.07), with somewhat higher risk observed in older people (OR 2.51, 95% CI 1.52 to 2.68). In people with CKD (5 trials, n=106 681), individual study OR of AKI due to current NSAID exposure ranged from 1.12 to 5.25, with pooled estimate OR 1.63 (95% CI 1.22 to 2.19).

A Canadian case-control study 1, which was based on a population of more than 200 000, compared patients who had been admitted for acute renal failure with randomly chosen controls from the general population. Of the 28 admitted patients 12 died. Seven of these 12 had a recent history of NSAID use. The use of NSAIDs increased the risk the risk of acute renal failure by 4.1-fold compared with non-users in whom the prevalence was 2/100 000 patient years. Age over 65 years, male gender, pain medication lasting less than one month, high dose, concomitant use of other nephrotoxic drugs and ASA, cardiovascular disease, and recent hospitalization for some other cause increased the risk of acute renal failure.

A systematic review and meta-analysis 3 evaluate the relationship between AKI and use of NSAIDs in hospitalized pediatric patients. The pooled odds ratio of AKI for present NSAID exposure was 1.55 (95%CI 1.26 to 1.92; 7 trials).

Comment: The quality of evidence upgraded by consistent effect.

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    References

    • Pérez Gutthann S, García Rodríguez LA, Raiford DS, Duque Oliart A, Ris Romeu J. Nonsteroidal anti-inflammatory drugs and the risk of hospitalization for acute renal failure. Arch Intern Med 1996 Nov 25;156(21):2433-9. [PubMed]
    • Zhang X, Donnan PT, Bell S et al. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol 2017;18(1):256. [PubMed]
    • Gong J, Ma L, Li M et al. Nonsteroidal anti-inflammatory drugs associated acute kidney injury in hospitalized children: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 2022;31(2):117-127. [PubMed]

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