The Case for Cautious Consumption: NSAIDs in Chronic Kidney Disease

Sriram Sriperumbuduri; Swapnil Hiremath


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

In This Article

NSAIDs in Dialysis

The caution with use of NSAIDs in nondialysis CKD unwisely also spills over into dialysis dependent CKD. Reviews of pain management in ESKD do not mention NSAIDs, and mention even acetaminophen only in passing, or as an afterthought.[5,32] Among anuric patients, there will be no effect on the glomerular blood flow, or on the tubular function, hence concerns of sodium retention, hypertension, and electrolyte disturbances are baseless and unwarranted. There is also no worry about AKI or worsening of CKD in anuric patients. The proportion of cardiovascular toxicity that may be mediated via volume and worsening heart failure also will be absent. This leaves gastrointestinal toxicity, and possible effect on platelet aggregation and vasoconstriction as potential mechanisms still important to consider. Dialysis patients are indeed at higher risk for gastrointestinal bleeding with NSAID use, and should be cautioned about this aspect. Could NSAIDs have an effect on residual kidney function? This potential adverse effect would be especially important for patients on peritoneal dialysis, and deserves further scrutiny and study. For all other ESKD patients, use of NSAIDs would seem to be a safer and effective option than non-NSAID alternatives.