Prescription Non-steroidal Anti-inflammatory Drugs: Pattern and Nephrotoxicity

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are very common “over-the-counter” commonly abused drugs used in treating fever, pain and inflammatory conditions. They inhibit prostaglandins and can cause kidney disease and hypertension, particularly in stressed states like dehydration and exercises.

Objectives: To access prescription pattern and effects of common NSAIDs on the kidneys.

Methods: One hundred frequent NSAIDs users (daily use > 4 weeks) and 100 healthy controls, who had no known risk factor for kidney disease and gave consent were recruited. Blood samples for serum electrolytes, urea and creatinine, haemoglobin concentration and urine samples for dip strip, and 24 hour protein were collected and analysed.

Results: The mean age of the controls, all NSAIDs users, NSAIDs users without kidney dysfunction (KD) and NSAIDs users with KD were 46.04 + 14.21 years, 46.5 + 14.2 years, 41.84 years + 14.52 yrs and 63.04 + 4.21 years respectively, P=0.03. The mean estimated glomerular filtration rate (eGFR) was significantly lower in frequent NSAIDs users than controls, P<0.001. Ibuprofen was the most nephrotoxic and, nephrotoxicity was positively related to combination therapy (P<0.001) and duration of use (P=0.03). Herbal medicines significantly increased the risk of KD, P=0.01. Predictors of KD were advancing age, longer duration of NSAIDs use, Ibuprofen use and combined NSAIDs.

Conclusion: Frequent NSAIDs use, common in Orthopaedic units, could be complicated by kidney dysfunction. Ibuprofen, followed by ketoprofen, was the most nephrotoxic. Observed risk factors for NSAIDs induced nephrotoxicity included advancing age, herbal remedies, Ibuprofen and combination therapy.