RESEARCH - NSAIDs increase risk of acute renal failure

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NSAIDs Increase Risk of Acute Renal Failure

By Will Boggs, MD

NEW YORK (Reuters Health) Nov 03 - The use of nonsteroidal anti-inflammatory

drugs (NSAIDs) significantly increases the risk of acute renal failure,

according to a report in the November 1st American Journal of Epidemiology.

" NSAIDs are associated not uncommonly with renal failure, " Dr. M.

Brophy from McGill University, Montreal, Quebec, Canada told Reuters Health.

" This rate of renal failure is approximately twice that observed for

myocardial infarction. Clinicians should, therefore, be concerned not only

about cardiac but also renal adverse effects and, therefore, restrict NSAID

use only for those situations where the benefit is expected to outweigh the

risks. "

Dr. Brophy and colleagues investigated the time-dependent association of

selective and nonselective NSAID use with acute renal failure, compared with

that for individuals not exposed to these drugs, in elderly patients. The

study included 4228 cases of acute renal failure matched on age to 84.540

controls.

Current new users of any NSAID had a risk of acute renal failure twice that

of unexposed individuals, the investigators found.

The risk was increased by 62% among current and recent NSAID users, the

results indicate, and only slightly increased (by 14%) among current

continuous users of NSAIDs.

The risk of acute renal failure was not elevated among individuals who had

recently stopped using NSAIDs, the researchers note, and was actually lower

among past NSAID users than among unexposed individuals.

The elevated risk of acute renal failure was similar for selective and

nonselective NSAIDs, the report indicates. High-dose rofecoxib appeared to

be the most nephrotoxic and low-dose celecoxib the least nephrotoxic.

" I think physicians should use the lowest possible dose of all NSAIDs for

the shortest possible period of time, " Dr. Brophy said. " Also, since the

risk is highest with current new users, it would seem appropriate to check

renal function shortly after debuting therapy -- perhaps 2 weeks. "

However, he concluded, " Since our results do not come from a randomized

controlled trial, there is always a chance that they may the result of bias

(selection or confounding). Therefore, it is important that this issue be

further addressed in a large randomized controlled trial. "

Am J Epidemiol 2006;164:881-889.

http://www.medscape.com/viewarticle/547191

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