Greater exposure to NSAIDs increases risk of kidney disorders

Abstract

Greater exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) appear to increase the risk of acute kidney injury (AKI) and chronic kidney disease (CKD; renal failure) in young and middle-aged adults, according to findings of a US study published in JAMA Network Open. This study used medical and administrative data to investigate the association between exposure to prescribed dosages of NSAIDs during the previous six months and the incidence of AKI and CKD in 764 228 active soldiers (mean age 28 years) serving in the US Army between January 2011 and December 2014. In total, 137 108 soldiers (17.9%) were dispensed up to seven defined daily doses (DDD) of NSAIDs per month, and 124 594 soldiers (16.3%) were dispensed more than seven DDD per month. The mean prescription was 1.6 DDD per month. The most frequently prescribed NSAIDs were ibuprofen and naproxen; 78.3% of ibuprofen prescriptions were for 800mg tablets and 88.4% permitted three or more doses per day, while 95.7% of naproxen prescriptions were for ≥500mg tablets and 93.8% permitted two or more doses per day. AKI was reported in 2356 soldiers (0.3%) and CKD was reported in 1634 soldiers (0.2%). The highest level of exposure to NSAIDs (≥7 DDDs) significantly increased the risk of AKI (adjusted hazard ratio [aHR] 1.2; 95% CI 1.1, 1.4) and the risk of CKD (aHR 1.2; 95% CI 1.0, 1.3), resulting in an additional 17.6 cases of AKI and 30.0 cases of CKD per 100 000 patients per year. Obesity, hypertension and rhabdomyolysis increased the HR for AKI and CKD. We have identified modest but statistically significant associations between the highest level of observed NSAID exposure and incident AKI and CKD among active, largely healthy adults in the military. While recognizing that the pain burden in such active populations must be managed using the best-available measures, given the relatively high mean DDD per prescription we observed, providing lower doses is one approach to those with pain and/or inflammation, said the researchers.