Excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs) appears to increase the risks of acute kidney injury and chronic kidney disease among active younger and middle-aged adults, according to new study findings.

Of 764,228 active-duty US soldiers (85.8% male; median age 27 years), 17.9% received 1 to 7 defined daily doses (DDD) of NSAIDs per month and 16.3% received more than 7. Over a median 2.4 person-years, 2356 cases of acute kidney injury (AKI) and 1634 new cases of chronic kidney disease (CKD) occurred.

Taking more than 7 NSAID doses per month compared with none was associated with a significant 20% increased risk of both AKI and CKD, Lianne M. Kurina, PhD, of Stanford University School of Medicine in Stanford, California, and colleagues reported in JAMA Network Open. The highest NSAID use was associated with an additional 17.6 and 30 cases of AKI and CKD, respectively, per 100,000 persons each year. Compared with whites, blacks had a 1.6- and 2.3-fold higher risk for AKI and CKD, respectively.

Hypertension, diabetes, rhabdomyolysis, and obesity significantly increased risks for kidney damage. Risks also increased with age.

Both selective and nonselective NSAIDs adversely affect the kidneys through prostaglandin-related effects, according to the investigators. Ibuprofen (800 mg, 3 or more times daily) and naproxen (500 mg, 2 or more times daily) were the most commonly prescribed NSAIDs. More than 5% of NSAID users were prescribed meloxicam or celecoxib.

“These potentially preventable cases are of particular concern in a population in which medical readiness is a foundation of national security,” Dr Kurina and her colleagues noted. While AKI and CKD commonly occur in older adults, most soldiers were younger than 35 years. According to the investigators, soldiers are more prone to intermittent dehydration that depletes fluid volume and increases the strain on the kidneys. They urged prescribers to be aware of potential kidney disease risks with higher NSAID doses and to consider dose reductions.

Reference

Nelson DA, Marks ES, Deuster PA, et al. Association of nonsteroidal anti-inflammatory drug prescriptions with kidney disease among active young and middle-aged adults. JAMA Network Open. 2019;2(2):e187896. DOI:10.1001/jamanetworkopen.2018.7896