NSAIDs Increase Risk of Acute Renal Failure

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. James 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."(Source: American Journal of Epidemiology : November 2006.)