Study suggests a review of NSAID prescribing practices

Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to relieve pain and inflammation. However, these medications have been linked to an increased risk of acute kidney injury.1 A newly published study from the University of Southampton highlights that those already at risk for acute kidney injury may still be prescribed NSAIDs. Results suggest the need to review NSAID prescribing protocol. 

What are NSAIDs?

Common NSAIDs, such as aspirin and ibuprofen are sold over the counter, without a prescription needed. 

NSAIDs are one of the most used medications to relieve pain; a 2016 survey representative of the England population revealed that 11% were taking an NSAID or a form of analgesia.2

Previous studies have linked NSAID use with the development of cardiovascular complications such as heart failure, myocardial infarction, and stroke.1 Other studies have linked NSAID use with gastrointestinal bleeding. The risk of NSAID-associated complications increases with duration of use, dose, and age of the individual. 

A potentially less studied side-effect of NSAID use is acute kidney injury. Acute kidney injurry is when the kidneys suddenly experience a reduction in functioning; if untreated, this can lead to a build-up of toxins and biochemicals in the body, which can prevent proper bodily functions. It can even lead to complete kidney failure, which may result in the need of a kidney transplant, the need for dialysis, or death.  

NSAIDs were prescribed to individuals “at-risk” for acute kidney injury

This study analyzed NSAID prescribing trends in Hampshire, U.K. over a two-year period. Researchers retrieved data for 702,265 individuals registered in the Care and Health Information Analytics database; this database included individuals who completed physician-ordered medical tests in Hampshire, U.K.1 Data was taken between October 1st, 2017 to September 30th, 2019. Individuals aged 18 or older were included in the study. 

The study population included subpopulations considered “at-risk” for acute kidney injury. Individuals with pre-existing comorbidities including cardiovascular disease, heart failure, chronic kidney disease, and older age were classified as “at-risk”. 

Of the overall study population, the rate of NSAID prescriptions administered decreased from 2.8% to 2.4% over the study period. For those considered “at-risk”, the rate of NSAID prescriptions decreased; those with chronic kidney disease had a decrease in NSAID prescriptions from 2.8 to 2.2% over the study period. 

According to the data obtained, individuals with cardiovascular disease or heart failure were less likely to be prescribed NSAIDS. However, there was no association found between NSAID prescription rate and history of chronic kidney disease. 

Being “at-risk” increases chances of experiencing acute kidney injury on NSAIDs 

Of the study population that was prescribed an NSAID, those aged 60 or older experienced a 65 to 657% higher risk of acute kidney injury within four months of being prescribed the NSAID compared to those aged 18 to 59.1

Individuals with a history of heart failure, chronic kidney disease, diabetes, hypertension, and cardiovascular disease were 41-78% more likely to experience acute kidney injury alerts within four months post-NSAID prescription than those without a history of these comorbidities.

A prior review study explored the risk of acute kidney injury when taking different NSAIDs; no significant difference was observed.3 

NSAID prescribing protocol should consider chronic kidney disease

Although people who were classified as “at-risk” for acute kidney injury tended to be prescribed less NSAIDs, the prescribing procedures still are not 100% safe, as some “at-risk” individuals still received NSAID prescriptions. 

Dr. Simon Fraser is an Associate Professor of Public Health at the University of Southampton and led this study. He noted, “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. GPs, nurse prescribers and pharmacists need to be aware and consider stopping (or not prescribing) NSAIDs in high-risk patients.”4 

Again, the results of this study failed to show an association between chronic kidney disease and NSAID prescription rates. The study authors suggested that emphasizing chronic kidney disease as a risk factor for acute kidney injury may help improve NSAID prescription protocol.1

The creation of a “NSAID-related acute kidney injury risk tool” was discussed, which would consider age and existing health conditions such as hypertension, diabetes, chronic kidney disease, etc. However, further research into a potential algorithm is needed. 

 References

  1. 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.
  2. Moody, A. et al. (2017). Health survey for England 2016: prescribed medicines. Retrieved from http://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. 

Image by Arek Socha from Pixabay 

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