Non-steroidal anti-inflammatory drug-associated acute kidney injury: does short-term NSAID use pose a risk in hospitalized patients?

Jeon, Nakyung; Park, Haesuk; Segal, Richard; Brumback, Babette; Winterstein, Almut G.

doi:10.1007/s00228-021-03121-0

Cited by 13 publications

(6 citation statements)

References 31 publications

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“…However, prolonged systemic use of NSAIDs is well documented as incriminated as a prime suspect for acute kidney events (Lim et al, 2022). Moreover, some studies suggested that NSAID use in hospitalized patients has been connected to an increased risk of AKI, particularly among those with impaired renal function (Jeon et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

The consequences of the arbitrary herbal and analgesics on renal function

Alreshidi¹,

ALmughais²,

Aboras³

et al. 2022

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Background: Many modifiable risk factors have been linked to the etiology of the increased renal disease worldwide. The objective of this study was to assess the consequences of arbitrary herbal and analgesics on renal function in a series of Saudi patients. Methodology: This study investigated 2944 Saudi volunteers who have joined during a cross-sectional survey conducted in Hai'l region. Renal function status was established corresponding to Glomerular infiltrating Rate (GFR) estimation using creatinine level, age, and sex. GFR was categorized into: Stage III CKD (GFR = <60 -30 mL/min). Stage IV (GFR = <30 -15 mL/min). Stage V (GFR = <15 mL/min). Results: Around 14.4% of participants claimed using non-steroidal anti-inflammatory drugs (NSAIDs). Of the 391 analgesics users, about 12.8% were found with impaired renal function. The risk of analgesics uses in deteriorating renal function, the relative risk (RR) and the 95% confidence interval (95%CI), RR (95%CI) = 1.7926 (1.3313 to 2.4137), P = 0.0001. Out of the 426/2714(15.7%) herbal users, 45/426(10.6%) were found with impaired renal function. The risk of herbal uses in deteriorating renal function, the RR (95%CI) = 1.3659 (1.0366 to 1.7999), P = 0.0268. Conclusion: Significant Reverse associations between arbitrary herbal use as well as, frequent NSAIDs renal function. The frequent use of Arbitrary herbal and NSAIDs is common among the Saudi Community, particularly among women.

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Section: Resultsmentioning

confidence: 99%

The consequences of the arbitrary herbal and analgesics on renal function

Alreshidi¹,

ALmughais²,

Aboras³

et al. 2022

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“…Preventing nephrotoxic drug exposure such as NSAID is another important issue in patients with kidney disease. 29 , 30 However, NSAIDs are still widely used worldwide. In the United States, about 19% of the population has used at least one type of NSAID in a year, and studies in Sweden and the United Kingdom have shown that about 15–17% of the elderly population over 60–65 years old use NSAIDs long term.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease

Wang,

Kang,

Chen

et al. 2024

PPA

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Purpose Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing to various comorbid conditions. This vulnerability is further compounded by an escalated risk of renal function deterioration when exposed to nephrotoxic medications. As part of the national health insurance program in Taiwan, the pre-end-stage kidney disease patient care and education plan has included pharmaceutical care since October 2021. This study aims to explore the effect of pharmacist involvement in a multidisciplinary care team for patients with kidney disease in outpatient settings. Patients and Methods This retrospective observational study was conducted at a single center. It analyzed data from May 2022 to May 2023, focusing on patients who received medication therapy management in the kidney disease pharmacist-managed clinic. The study assessed changes in patient medication adherence, non-steroidal anti-inflammatory drugs (NSAIDs) usage, CKD stage, and urine protein-to-creatinine ratio (UPCR) after pharmacist intervention. It also documented pharmacists’ medication recommendations and the rate of acceptance by physicians. Results A total of 202 patients who had at least two clinic visits were included in the study. After pharmacist intervention, the proportion of poor medication adherence reduced significantly from 67.8% to 43.1% (p<0.001). The proportion of NSAID users also decreased significantly from 19.8% to 8.4% (p=0.001). CKD stage showed a significant reduction (p=0.007), and the average UPCR improved from 2828.4 to 2111.0 mg/g (p<0.001). The pharmacists provided a total of 56 medication recommendations, with an acceptance rate of 86%. Conclusion The involvement of pharmacists in the multidisciplinary care team can effectively provide medication-related recommendations, ensuring the effectiveness and safety of patients’ medication use, and lead to better kidney function and lower proteinuria.

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“…Standard ICU clinical practices, which include close monitoring of creatinine, early fluid resuscitation, and stress ulcer prophylaxis, can reduce, or mitigate adverse outcomes from NSAID use [58,59]. For example, studies in hospitalized patients with preserved kidney function have found that short-term NSAID use was not associated with an increased risk of AKI [60][61][62]. Even in cases of NSAID-induced AKI, cessation of the drug and fluid resuscitation usually led to a favourable prognosis and was not associated with progression to receipt of long-term dialysis [63,64].…”

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatories for analgesia in critically ill patients: a systematic review and meta-analysis of randomized control trials

Tworek

Kung

et al. 2023

Preprint

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Purpose: While opioids are part of usual care for analgesia in the intensive care unit (ICU), there are concerns regarding excess use. This is a systematic review of non-steroidal anti-inflammatories (NSAIDs) use in critically ill adult patients. Methods: We conducted a systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library. We included randomized control trials (RCTs) comparing NSAIDs alone or as an adjunct to opioids for analgesia. The primary outcome was opioid utilization. We reported mean difference for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence intervals (CIs). We evaluated study risk of bias using the Cochrane risk of bias tool and evidence certainty using GRADE. Results: We included 15 RCTs (n=1621 patients). Adjunctive NSAID therapy to opioids reduced 24-hour oral morphine equivalent consumption by 21.4mg (95% CI: 11.8-31.0mg reduction, high certainty) and probably reduced pain scores (measured by visual analogue scale) by -6.1mm (95% CI: -12.2 to +0.1, moderate certainty). Adjunctive NSAIDs probably had no impact on duration of mechanical ventilation (-1.6 hours, 95% CI: -0.4 to -2.7 hours, moderate certainty) and may have no impact on ICU length of stay (-2.1 hours, 95% CI: -6.1 to +2.0 hours, low certainty). Variability in reporting of adverse outcomes (e.g. gastrointestinal bleeding, acute kidney injury) precluded their meta-analysis. Conclusion: In critically ill adult patients, NSAIDs reduced opioid use, probably reduced pain scores, but were uncertain for duration of mechanical ventilation or ICU length of stay. Further research is required to characterize the prevalence of NSAID-related adverse outcomes.

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Non-steroidal anti-inflammatory drug-associated acute kidney injury: does short-term NSAID use pose a risk in hospitalized patients?

Cited by 13 publications

References 31 publications

The consequences of the arbitrary herbal and analgesics on renal function

The consequences of the arbitrary herbal and analgesics on renal function

The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease

Non-steroidal anti-inflammatories for analgesia in critically ill patients: a systematic review and meta-analysis of randomized control trials

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