Reevaluating NSAID Prescribing Practices: Insights from Recent Study Findings

Impact of NSAIDs on Kidney Health

Understanding NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to alleviate pain and inflammation. Common NSAIDs, such as aspirin and ibuprofen, are available over the counter without a prescription. A survey conducted in 2016 indicated that 11% of the population in England were using NSAIDs or similar analgesics. However, previous research has associated NSAID use with various complications, including cardiovascular issues like heart failure, myocardial infarction, and stroke, as well as gastrointestinal bleeding.

The risk of complications related to NSAIDs tends to increase based on the duration of use, dosage, and the age of the individual. A less frequently discussed side effect of NSAIDs is acute kidney injury (AKI). This condition occurs when the kidneys suddenly reduce their functioning, potentially leading to toxic build-up in the body and severe health consequences, including complete kidney failure, dialysis, or even death.

NSAID Prescriptions for At-Risk Individuals

A recent study conducted by the University of Southampton examined NSAID prescribing trends in Hampshire, U.K., over two years. Researchers analyzed data from 702,265 individuals registered in the Care and Health Information Analytics database, which included patients who underwent physician-ordered medical tests from October 1, 2017, to September 30, 2019. The study focused on individuals aged 18 and older, particularly those considered at risk for acute kidney injury due to pre-existing conditions such as cardiovascular disease, heart failure, chronic kidney disease, or older age.

Over the study period, the overall rate of NSAID prescriptions decreased from 2.8% to 2.4%. Notably, the rate among individuals with chronic kidney disease declined from 2.8% to 2.2%. While individuals with cardiovascular disease or heart failure were less likely to receive NSAID prescriptions, no significant correlation was observed between NSAID prescription rates and a history of chronic kidney disease.

Increased Risk of Acute Kidney Injury

Among those prescribed NSAIDs, individuals aged 60 and above were found to have a 65% to 657% higher risk of experiencing acute kidney injury within four months of receiving their prescription compared to younger individuals aged 18 to 59. Furthermore, individuals with a history of heart failure, chronic kidney disease, diabetes, hypertension, and cardiovascular disease had a 41% to 78% increased likelihood of experiencing acute kidney injury alerts within the same timeframe.

A previous review indicated no significant differences in the risk of acute kidney injury among various NSAIDs, underscoring the need for careful consideration when prescribing these medications.

Recommendations for NSAID Prescribing Protocol

While the data suggest that individuals classified as at risk for acute kidney injury were prescribed fewer NSAIDs, the current prescribing practices still pose risks, as some at-risk patients continued to receive prescriptions. Dr. Simon Fraser, an Associate Professor of Public Health at the University of Southampton and leader of the study, emphasized the need for prescribers to be more vigilant regarding the risk of acute kidney injury. He stated, “Most prescribers are well aware of the risks of NSAIDs, particularly of inflammation and bleeding in the gastrointestinal tract, but our study reveals a need for greater attention to this acute kidney injury risk.”

The findings of this study did not demonstrate a clear association between chronic kidney disease and NSAID prescription rates. The authors suggested that highlighting chronic kidney disease as a risk factor for acute kidney injury could enhance NSAID prescribing protocols. They proposed the development of an NSAID-related acute kidney injury risk tool that would take into account factors such as age and existing health conditions like hypertension and diabetes, although further research is needed to create a reliable algorithm.

References

1. Lin, S.X. et al. (2022). Characterizing risk of non-steroidal anti-inflammatory drug-related acute kidney injury: A retrospective cohort study. BJGP Open; BJGPO.2021.0208. doi: 10.3399/BJGPO.2021.0208.
2. Moody, A. et al. (2017). Health survey for England 2016: prescribed medicines. Retrieved from https://healthsurvey.hscic.gov.uk/media/63790/HSE2016-pres-med.pdf.
3. Ungprasert, P. et al. (2015). Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: a systematic review and meta-analysis of observational studies. European Journal of Internal Medicine; 26(4): 285-291. doi: 10.1016/j.ejim.2015.03.008.
4. Bates, S. (2022). Southampton-led study shows need for painkiller caution to prevent kidney damage. EurekAlert! Accessed on Feb. 23, 2022. Retrieved from https://www.eurekalert.org/news-releases/943812.