Use of nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the short-term risk for acute kidney injury (AKI) and hyperkalemia in patients with diabetes mellitus, especially when patients are already taking a diuretic or renin-angiotensin-aldosterone-system inhibitor (RAASi), investigators reported at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.

Patients with diabetes mellitus and microvascular kidney disease may be susceptible to NSAID-induced AKI, Cynthia C. Lim, MD, and colleagues from Singapore General Hospital noted.

In a cohort of 3896 hospitalized patients with new drug prescriptions, the primary outcome of AKI and/or hyperkalemia within 30 days developed in 525 (13.5%). In an adjusted model, the presence of cardiovascular disease, RAASi use, diuretic use, and elevated potassium at baseline significantly correlated with 41%, 42%, 91%, and 36% increased risks for the primary outcome, respectively.

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A total of 138 patients received an NSAID prescription for a more than a 14-day supply. Such use was associated with a significant 65% greater risk for AKI or hyperkalemia within 30 days, Dr Lim’s team reported.

Concurrent prescribing of an NSAID with a diuretic or RAASi was significantly associated with 3.3- and 4.2-fold increased odds of AKI or hyperkalemia, respectively.


Lim CC, Abdul Kadir HB, Jun JCC, Ang TW, Bee YM, Tan NC. Nonsteroidal anti-inflammatory drugs and risk of acute adverse renal outcomes in diabetes. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0028.