Of NSAIDs, ibuprofen poses lowest risk for kidney function decline
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In a cohort of Chinese patients with normal kidney function at baseline, NSAIDs had varying impacts on eGFR decline, with ibuprofen posing the lowest risk and etoricoxib posing the highest risk.
“[NSAIDs] have been one of the most commonly prescribed drugs in many countries, including the United States, for the treatment of pain and inflammation,” Eric Yuk Fai Wan, BSc, MSc, PhD, of the Centre for Safe Medication Practice and Research in the department of pharmacology and pharmacy at the University of Hong Kong, and colleagues wrote. “Nonetheless, association between the exposure of NSAIDs and incident CKD has been questioned since the 1950s. The risk of developing CKD in relation to chronic use of NSAIDs remains inadequately explored.”
As the researchers contended most evidence on this topic “has mainly focused on the White population in the United States and Europe,” it is important to examine the effects of NSAIDs in other populations, because “Asians might be more susceptible to kidney failure when compared with Whites.”
Therefore, using the Hong Kong Hospital Authority’s clinical database, Wan and colleagues included a cohort of individuals who had an eGFR of 60 mL/min/1.73 m2 or greater between 2008 and 2017 (n = 1,889,692; mean age, 55 years; 47% were men).
The associations between nine types of oral NSAIDs (celecoxib, etoricoxib, diclofenac, ibuprofen, indomethacin, mefenamic acid, naproxen, piroxicam and sulindac) with either an incident eGFR of less than 60 mL/min/1.73m2 or eGFR decline of at least 30% from baseline value were determined (8% of the study population was prescribed an NSAID, with diclofenac being most common). Participants were followed for a median of 6.3 years.
“Previous studies reported that the incidence of NSAID-associated adverse events would significantly increase after 4 consecutive weeks of treatment,” the researchers wrote. “Hence, NSAID treatment in this study was defined as prescription of NSAIDs for a minimum of 28 [days/month] to avoid random effect due to short-term or one-off NSAID treatment.”
Results showed that compared with no NSAIDs, any NSAID treatment was associated with a higher risk for incident eGFR less than 60 mL/min/1.73 m2 (hazard ratio = 1.71) and an eGFR decline of at least 30% (HR = 1.93).
When comparing risks between NSAIDs, researchers found users of ibuprofen had the lowest risk for incident eGFR less than 60 mL/min/1.73 m2 (HR = 1.12) and eGFR decline of at least 30% (HR = 1.31), while etoricoxib users had the highest risk for both outcomes (HRs of 3.12 and 3.11, respectively).
“In general, the effect of NSAID treatment on kidney outcomes was similar between men and women, but it was attenuated in older individuals, those who took antihypertensive drugs, and those with a higher Charlson comorbidity index,” the researchers added.
According to Wan and colleagues, these findings suggest ibuprofen is the safest choice if an NSAID prescription is deemed necessary.
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