Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with higher risks for an incident estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) below 60 and an eGFR decline of 30% or greater, investigators reported in the Clinical Journal of the American Society of Nephrology.
The study examined the effect of 9 oral NSAIDs on kidney function in a retrospective cohort of 1,982,488 Chinese individuals in Hong Kong aged 18 years or older with an eGFR higher than 60.
Overall, NSAID treatment — defined as a prescription for NSAIDs for a minimum of 28 days — was significantly associated with a 71% increased risk of incident eGFR less than 60, 93% increased risk of an eGFR decline of 30% or greater, and 88% increased risk of the composite of either outcome compared with no NSAID use, Eric Yuk Fai Wan, MD, of The University of Hong Kong, and colleagues reported.
Ibuprofen was the safest NSAID, conferring a significant 12% increased risk of incident eGFR less than 60, 32% increased risk of an eGFR decline of 30% or greater, and 34% increased risk of the composite outcome. Etoricoxib had the largest negative effect on kidney function. Its use was significantly associated with a 3.1-fold increased risk of both incident eGFR less than 60 and eGFR decline of 30% or greater as well as the composite of either outcome.
The incidence rates for an eGFR less than 60, an eGFR decline of 30% or greater, and the composite outcome were 33.0, 62.1, and 68.0 cases per 1000 person-years, respectively, for any NSAID use compared with 22.8, 33.4, and 36.8 per 1000 person-years for no NSAID use.
For the study, Dr Wan and colleagues used the clinical database maintained by the Hong Kong Hospital Authority, which manages the public health care sector in Hong Kong.
Individuals in the study had an average age of 55 years, and 47% were men. The investigators limited their analysis to 154,991 individuals who used NSAIDs and 1,734,701 who did not. During a median follow-up duration of 6.3 years, 271,848 cases of incident eGFR less than 60 and 388,386 events of an eGFR decline of 30% or greater occurred.
The other NSAIDs included in the study were celecoxib, diclofenac, indomethacin, mefenamic acid, naproxen, piroxicam, and sulindac.
With regard to study limitations, the investigators explained that the database they used for the study did not cover all NSAIDs available in Hong Kong because of formulary restrictions. In addition, the study did not capture over-the-counter NSAID use and did not take into account patients’ drug adherence, which could vary among NSAID users, the investigators pointed out.
Wan EYF, Yu YET, Chan L, et al. Comparative risks of nonsteroidal anti-inflammatory drugs on CKD. Clin J Am Soc Nephrol. Published online April 28, 2021. doi:10.2215/CJN.18501120