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

Abstract

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of adverse drug events (ADEs), but renal risks of NSAIDs are less well quantified than gastrointestinal and cardiac risks. This paper reports a systematic review of published population-based observational studies examining the risk of acute kidney injury (AKI) associated with NSAIDs in community-dwelling adults and those with pre-existing chronic kidney disease (CKD).MethodsMEDLINE and EMBASE databases were searched until June 2016, and 3789 papers screened. Ten studies reporting NSAID risk of AKI in the general population were included in random effects meta-analysis, of which five additionally reported NSAID risk in people with CKD.ResultsIn the general population, 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, 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).ConclusionsNo study reported baseline risk of AKI in different populations meaning absolute risks could not be estimated, but baseline risk and therefore the absolute risk of NSAID exposure is likely to be higher in people with CKD and older people. Large population based studies measuring AKI using current definitions and estimating the absolute risk of harm are needed in order to better inform clinical decision making.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0673-8) contains supplementary material, which is available to authorized users.

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (April 2020)

“…It has been theorized that NSAIDs, due to upregulation in ACE2 in human target cells, may lead to a more severe course of COVID-19 in those taking NSAIDs. While no causal evidence of adverse outcomes with NSAIDs in the management of COVID-19 have been published, there are well known risks of non-steroidal anti-inflammatory agents including cardiovascular, gastrointestinal and renal adverse events [64,65]. In the setting of bacterial pneumonia, NSAIDs may impair recruitment of polymorphonuclear cells, resulting in a delayed inflammatory response and resolution of infection, however a causal relationship has not been established [66,67].…”

Cost‐Effectiveness of Pharmacist‐Led Deprescribing ofNSAIDsin Community‐Dwelling Older Adults

“…Nonsteroidal anti‐inflammatory drugs (NSAIDs) are widely prescribed to older adults for the management of pain and inflammation. However, these medications are associated with adverse outcomes such as dyspepsia, gastrointestinal (GI) bleeding, acute myocardial infarction (MI), and acute kidney injury . The long‐term use of NSAIDs puts older adults at greater risk of experiencing these adverse outcomes.…”

Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging

“…Diclofenac can cause interstitial nephritis, nephrotic syndrome and glomerulonephritis and can even lead to acute kidney injury or chronic kidney disease. It is potentially harmful in patients at risk for renal function impairment . Other adverse events of diclofenac treatment besides platelet and kidney dysfunction are gastrointestinal disorders including NSAID enteropathy with intestinal blood and protein loss, peptic ulcer and less frequently also upper gastrointestinal bleeding .…”

“…It is potentially harmful in patients at risk for renal function impairment. [1][2][3][4][5] Other adverse events of diclofenac treatment besides platelet and kidney dysfunction are gastrointestinal disorders including NSAID enteropathy with intestinal blood and protein loss, peptic ulcer and less frequently also upper gastrointestinal bleeding. [6] In addition, hepatotoxicity causing acute liver failure has been linked to NSAID therapy.…”