Ibuprofen may increase the risk for acute kidney injury (AKI) in hospitalized children, particularly those with chronic kidney disease (CKD), a new study finds.

In a cohort of 50,420 hospitalized children aged 1 month to 18 years (60.8% male) in China, 5526 (11.0%) received ibuprofen and 3476 (6.9%) experienced hospital-acquired AKI. Ibuprofen use was significantly associated with an adjusted 23% increased risk of AKI, defined as an increase in serum creatinine of 26.5 μmol/L or more within 48 hours or by 50% or more over baseline, corresponding author Xin Xu, MD, PhD, of the National Clinical Research Center for Kidney Disease at Southern Medical University in Guangzhou, China, and colleagues reported in JAMA Network Open.

The risk for ibuprofen-associated AKI increased with age. Ibuprofen use was significantly associated with a 64% increased risk among adolescents older than 10 years compared with a 36% increased risk among children aged 1 to 10 years. Babies up to 1 year old had no increased risks. Children with CKD who used ibuprofen had a 2.3-fold increased risk of AKI, whereas children without CKD who used the pain reliever had a 1.2-fold increased risk. In addition, young patients taking ibuprofen who required intensive care had an increased risk for AKI compared with those who did not (47% vs 18%).

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Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is a nonselective blocker of cyclooxygenase. It inhibits the synthesis of prostaglandin, which leads to vasoconstriction, increased preglomerular resistance, decreased renal perfusion, and increased risk of prerenal AKI, according to the study authors. Ibuprofen is frequently prescribed in children for diverse therapeutic indications, including fever, postoperative pain, tumors, and inflammatory disorders.

In the study, as cumulative doses of ibuprofen increased so did AKI risk. Children with AKI tended to have a higher cumulative dose of ibuprofen than children without AKI: median 13.45 vs 12.02 mg/kg. The investigators found no interactions between ibuprofen and use of angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, diuretics, proton pump inhibitors, other NSAIDs, or contrast media.

“Results of this study suggest that pediatricians should be aware of the potentially increased risk of acute kidney injury associated with a high dose of ibuprofen among hospitalized children; judicious use of ibuprofen and close monitoring of kidney function are necessary,” Dr Xu and collaborators concluded.


Su L, Li Y, Xu R, et al; for the EACH Study Investigators. Association of ibuprofen prescription with acute kidney injury among hospitalized children in China. JAMA Netw Open. 2021;4(3):e210775. doi:10.1001/jamanetworkopen.2021.0775