The Case for Cautious Consumption: NSAIDs in Chronic Kidney Disease

Sriram Sriperumbuduri; Swapnil Hiremath

Disclosures

Curr Opin Nephrol Hypertens. 2019;28(2):163-170. 

In This Article

Conclusion: The Case for Cautious use

Could one rely upon NSAIDs as an analgesic option despite having the known adverse effects on kidney? There is little doubt that NSAIDs have effective anti-inflammatory and analgesic effect. Conversely, they are associated with a nonnegligible risk of AKI, a low but real risk of worsening hypertension, and a low risk of long-term worsening of kidney function, especially with a high cumulative usage. Not discussed here, but also relevant are their increased gastrointestinal and cardiovascular adverse effects. The alternative to not using NSAIDs are also not pleasant and come with a different set of adverse effects.[51] Hence, rather than complete avoidance of NSAIDs in CKD, an argument could be made for cautious and deliberate use (Table 2 and Table 3). Close monitoring of BP and biochemical parameters after NSAID initiation, coupling and limiting dose and duration to analgesic need, and use of nonpharmacological adjuncts for pain relief should be used to guide therapy.

These suggestions for NSAID use are no risk proof. Here comes the role for shared decision making. The trade-offs inherent in using a drug with adverse effects deserve discussion with the individual patient. Patients and their care partners should be made part of the decision making, as only they can weigh the value of immediate and better pain relief against the longer term risk of sometimes irreversible kidney disease.[52]

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