Ibuprofen Safest NSAID for Patients with Chronic Kidney Disease, claims study
Both over-the-counter and prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used all over the world. In a recent study, researchers have reported that the NSAIDs increases the 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. They also found that ibuprofen is comparatively safer than etoricoxib for patients with CKD. The study findings were published in the Clinical Journal of the American Society of Nephrology on April 28, 2021.
Although NSAIDs are commonly used for the management of inflammation and pain, several guidelines including, the Kidney Disease Initiative Global Outcome (KDIGO) guidelines, recommended avoidance of NSAIDs (except aspirin and acetaminophen) for most patients with chronic kidney disease (CKD). The difference between risks of individual nonsteroidal anti-inflammatory drugs also remains unclear. Therefore, researchers of the University of Hong Kong conducted a study to evaluate the association between NSAID exposure and the risk of incident eGFR <60 ml/min per 1.73 m2 and compare the risks between nonsteroidal anti-inflammatory drug subtypes in the Chinese population.
It was a retrospective study of 1,982,488 subjects aged 18 years or older with baseline eGFR ≥60 ml/min per 1.73 m2. The researchers used multivariable Cox proportional hazards regression adjusted for each patient's baseline characteristics to examine the association between nonsteroidal anti-inflammatory drug and incident eGFR <60 ml/min per 1.73 m2 or eGFR decline ≥30% with baseline reference.
Key findings of the study were:
- After a median follow-up duration of 6.3 years, the researchers identified 14% of incident eGFR <60 ml/min per 1.73 m2 and 21% events of eGFR decline ≥30%.
- After adjusting for each patient's baseline characteristics, they found that NSAIDs significantly increases the risk of incident eGFR <60 ml/min per 1.73 m2 (hazard ratio, 1.71) and eGFR decline ≥30% (HR1.93) when compared with no NSAID.
- They noted that among NSAIDs, etoricoxib exhibited the highest risk of eGFR<60 ml/min per 1.73 m2 (HR, 3.12) and eGFR decline ≥30% (HR, 3.11) and ibuprofen displayed the lowest risk of eGFR<60 ml/min per 1.73 m2 (HR, 1.12) and eGFR decline ≥30% (HR, 1.32).
The authors concluded, "Nonsteroidal anti-inflammatory drug exposure was associated with higher risks of incident eGFR <60 ml/min per 1.73 m2 and eGFR decline ≥30%. Highest risk was observed in etoricoxib users, and lowest risk was with ibuprofen."
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