A recent study to emerge from the University of Southampton, England, has revealed a link between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and an increased risk of acute kidney infection (AKI). The findings suggest the need for a review of NSAID prescribing practices to protect at-risk patients.
In ophthalmology, NSAIDs are commonly used for pain and photophobia after photorefractive surgery and to reduce miosis, inflammation, and cystoid macular edema following cataract surgery.1 Administered topically on the eye surface, NSAIDs provide patients therapeutic advantages to relieve redness, swelling and inflammation.
healthcare professionals who prescribed NSAIDs were commonly aware of the risk of inflammation and bleeding in the gastrointestinal track, but not as likely the risk of AKI
While previous studies have linked NSAID use with the development of cardiovascular complications, the side-effect of AKI, until now, was lesser known. AKI occurs when kidneys experience a sudden reduction in functioning which, if left untreated, can lead to a build-up of toxins and biochemical in the body, affecting proper bodily functions.
The retrospective two-year closed-cohort study analysed NSAID prescribing trends in Hampshire, England, and received data for 702,265 individuals between 1 October 2017 and 20 September 2019. The population included patients considered at-risk for AKI, including older patients, those with cardiovascular disease (CVD), heart failure, and chronic kidney disease (CKD).
Among the study cohort prescribed NSAIDs, people of older age groups experienced between 65% (OR 1.65, 95% CI = 1.27 to 2.18, P<0.001) and 657% (OR 7.57, 95% CI = 5.53 to 10.42, P<0.001) more risk of AKI alerts within four months of prescription than the youngest group; those with greater social deprivation were more likely to have AKI alerts (19%–69%); and the disease group with history of CKD, CVD, heart failure, diabetes, and hypertension were 41%-78% more likely to have AKI alerts. No significant differences were present between male and female groups. Absolute risk of first AKI was highest among those aged ≥80 years, with greater combinations of hypertension, diabetes, CKD, CVD, and heart failure, and those from lower socioeconomic groups.2
Overall, the study found that patients with known risk factors of AKI were prescribed NSAIDs less frequently than those without any risk factors. However, a minority of those with known risk factors, were still prescribed NSAIDs. This important population presents the greatest concern as researchers believe it may suggest that medical professionals prescribing NSAIDs are not strongly deterred by patients AKI risk factors, even those as serious as CKD or heart failure.
Dr Simon Fraser, an Associate Professor of Public Health at the University of Southampton, and study-lead, noted that healthcare professionals who prescribed NSAIDs were commonly aware of the risk of inflammation and bleeding in the gastrointestinal track, but not as likely the risk of AKI. He urged prescribers to be aware, and to consider not prescribing NSAIDs to patients at high-risk of AKI.
The authors concluded that, despite generally good prescribing practice, new medication review and NSAID deprescribing for some people at high risk of AKI, should be considered.2
- Schoenberger, S. D., & Kim, S. J. (2013). Nonsteroidal anti-inflammatory drugs for retinal disease. International journal of inflammation, 2013, 281981. https://doi.org/10.1155/2013/281981
- Lin, S.X. et al. (2022). Characterizing risk of no-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study. BJGP Open; BJGPO.2021.0208. doi: 10.3399/BJGPO.2021.0208