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The case for cautious consumption

NSAIDs in chronic kidney disease

Sriperumbuduri, Sriram; Hiremath, Swapnil

Current Opinion in Nephrology and Hypertension: March 2019 - Volume 28 - Issue 2 - p 163–170
doi: 10.1097/MNH.0000000000000473
CLINICAL NEPHROLOGY: Edited by David S. Goldfarb
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Purpose of review Strong epidemiological and pathologic evidence associates NSAIDs with kidney disease, both acute and chronic. Hence, the usage of NSAIDs has decreased in patients with, or at risk for, chronic kidney disease (CKD). Coupled with this has been a rise in use of opioids and other non-NSAID alternatives, which do come with significant, and underrecognized, risk of nonrenal adverse events. We review the literature to understand if this shift is appropriate or deleterious.

Recent findings NSAIDs do have a low but tangible risk in causing acute kidney injury, electrolyte imbalances, and increasing blood pressure. However, their role in causing progressive kidney disease is due to long-term usage in high cumulative dosages, and the use of NSAIDs in combination with other agents. Alternatives such as opioids, tramadol, gabapentin and baclofen have weak evidence to support their use and strong evidence to show their harm in patients with CKD.

Summary Tradeoffs are inherent in using active pharmaceuticals, and NSAIDs are no exception. Balancing potential benefits with possible adverse effects around pain management should be a part of every conversation for patients with kidney disease.

Department of Medicine & Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Correspondence to Swapnil Hiremath, MD, MPH, ORCID 0000-0003-0010-3416, Department of Medicine & Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr, Ottawa, ON, Canada K1H7W9. Tel: +1 613 738 8400x82762; fax: +1 613 738 8337; e-mail: shiremath@toh.ca

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