Is There an Increased Risk of Kidney Failure with Long-term Use of NSAIDS?
Clinical Question
See title above.
Clinical Bottom Lines
- There appears to be an increased risk of end-stage renal disease with
chronic use of high doses of NSAIDS and moderate to high doses of
Acetaminophen.
- There appears to be a protective effect with long-term use of aspirin on
the development of ESRD.
See Comments below
The Evidence
| Intake |
|
Odds Ratio (95% CI) |
|
|
Acetaminophen |
NSAIDS |
Aspirin |
| Moderate |
1.4 (0.8 - 2.4) |
0.8 (0.4 - 1.5) |
0.8 (0.5 - 1.3) |
| High |
2.1 (1.1 - 3.7) |
1.0 (0.5 - 2.0) |
1.1 (0.7 - 1.9) |
| Mod. Cumulative |
2.0 (1.3 - 3.2) |
0.6 (0.3 - 1.1) |
0.5 (0.3 - 0.7) |
| High Cumulative |
2.4 (1.2 - 4.8) |
8.8 (1.1 - 71.8) |
1.0 (0.6 - 1.8) |
Comments
- This was a case-controlled study, and its validity is somewhat challenged
due to:
- recall and interviewer bias
- differences between comparison groups, however this was adjusted for in the
analysis
- questions were about drug use that predated the initiation of hemodialysis,
and it is assumed that this is the working criteria for the diagnosis of ESRD
- Despite these flaws in validity, the statistical analysis was rigorous.
- In addition to the above table, adjustment were also made for other
possible confounding factors:
- Diabetes Mellitus
- Hypertension
- Other Specified Causes
- No Known Cause
- After adjusting for these, no significant changes were apparent from the
above listed Odds Ratios.
- In terms of Number Needed to Harm, 1/42 patients for high cumulative doses
of acetaminophen, 1/52 patients for high cumulative doses for NSAIDS; In terms
of Number Needed to Treat, 1/17 patients treated with high cumulative doses of
aspirin was associated with a protective effect.
- Overall, however, the confidence intervals around the OR's for the high
cumulative dose groups were quite wide, with the lower limits close to 1.0. The
precision here is low, and this interview recommends taking these results with a
"grain of salt."
APPRAISED BY: Patrick Sousa, MD
DATE: November 1995
Perneger TV, et al. Risk of Kidney Failure with the Use of
Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs. NEJM
1994;331:1675-1679.
