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Non-steroidal Anti-inflammatory Drugs: Clinical Implications, Renal Impairment Risks, and AKI

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Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common class of drugs utilized for a variety of disorders, including headaches, pain states, fever, and other common conditions. In recent years, a link between NSAIDs and adverse effects has been identified, including renal, heart, and liver disease, bleeding, and increased mortality. NSAID-mediated renal disease is associated with interference with the cyclooxygenase enzyme. Literature evaluating NSAID renal effects has indicated that a number of factors are associated with acute and chronic kidney injury (AKI). Early diagnosis can identify changes in renal function and allow for cessation of NSAID use, limiting the risk for long-term chronic renal disease and in some cases reversal of renal injury. Alternative medications should be considered in those patients identified with morbidity linked to NSAID use. Nephrotoxicity is increased in the elderly population and in hypovolemia, high dose exposure, use of vasoconstrictors such as calcineurin inhibitors, and use of renin–angiotensin–aldosterone system (RAAS) inhibitors or diuretics. Careful risk/benefit considerations from healthcare professionals can limit the incidence and degree of morbidity and mortality, including in NSAID-mediated renal disease. Selective NSAID cyclooxygenase-2 inhibitors also possess risks and therefore clinicians should always recommend short-term courses of this class of drugs versus long-term dosing because of the risk of morbidity and mortality. Given that these drugs are available over the counter as well by prescribing, clinicians must communicate the risks and benefits of NSAIDs and provide sound recommendations to their patients regarding use short and long term.

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Fig. 1

Reprinted with permission from Elsevier. https://doi.org/10.1016/j.jfma.2021.02.013

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Permission has been granted by the author. https://tmedweb.tulane.edu/pharmwiki/doku.php/nsaid_side_effects

Fig. 3

Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. https://www.researchgate.net/publication/259722202_Risk_of_stroke_associated_with_nonsteroidal_anti-inflammatory_drugs

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Author Contributions

John M. LaForge, BS, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Kelsey Urso, CRC, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Juan Martin Day, BS, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Cade W. Bourgeois, BS, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Maggie M. Ross, BS, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Shahab Ahmadzadeh, MD, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Sahar Shekoohi, PhD, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Elyse M. Cornett, PhD, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Adam M. Kaye, PharmD, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Alan David Kaye MD, PhD, Study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis.

Disclosures

All authors have nothing to disclose.

Compliance with Ethical Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Data Availability

Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.

Author information

Authors and Affiliations

  1. School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    John M. LaForge, Cade W. Bourgeois & Maggie M. Ross

  2. Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Northwestern University, 420 E Superior St, Chicago, IL, 6061, USA

    Kelsey Urso

  3. School of Medicine, Texas A&M University, 400 Bizzell St, College Station, TX, 77843, USA

    Juan Martin Day

  4. Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett & Alan David Kaye

  5. Thomas J. Long School of Pharmacy and Health Sciences, Department of Pharmacy Practice, University of the Pacific, Stockton, CA, 95211, USA

    Adam M. Kaye

  6. Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Alan David Kaye

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  1. John M. LaForge
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Correspondence to Elyse M. Cornett.

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LaForge, J.M., Urso, K., Day, J.M. et al. Non-steroidal Anti-inflammatory Drugs: Clinical Implications, Renal Impairment Risks, and AKI. Adv Ther 40, 2082–2096 (2023). https://doi.org/10.1007/s12325-023-02481-6

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