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NSAIDs in CKD: Are They Safe?
Am J Kidney Dis. 2020 May 30 [Online ahead of print]AJ

Abstract

The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have increased susceptibility to adverse drug effects due to altered drug metabolism and excretion, and there are limited safety data for use in this population despite a high pain burden. Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been regarded as dangerous for use in patients with CKD because of their risk for nephrotoxicity and thus alternative classes of analgesics, including opioids, have become more commonly used for pain control in this population. Given the well-established risks that opioids and other analgesics pose, further characterization of the risk posed by NSAIDs in patients with CKD is warranted. NSAID use has been associated with acute kidney injury, progressive loss of glomerular filtration rate in CKD, electrolyte derangements, and hypervolemia with worsening of heart failure and hypertension. The risk for these nephrotoxicity syndromes is modified by many comorbid conditions, risk factors, and characteristics of use, and in patients with CKD, the risk differs between levels of glomerular filtration rate. In this review, we offer recommendations for the cautious use of NSAIDs in the CKD population after careful consideration of these risk factors on an individualized basis.

Authors+Show Affiliations

Department of Medicine, Yale University School of Medicine, New Haven, CT.Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Department of Medicine, Veterans Affairs Medical Center, West Haven, CT. Electronic address: mark.perazella@yale.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32479922

Citation

Baker, Megan, and Mark A. Perazella. "NSAIDs in CKD: Are They Safe?" American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 2020.
Baker M, Perazella MA. NSAIDs in CKD: Are They Safe? Am J Kidney Dis. 2020.
Baker, M., & Perazella, M. A. (2020). NSAIDs in CKD: Are They Safe? American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. https://doi.org/10.1053/j.ajkd.2020.03.023
Baker M, Perazella MA. NSAIDs in CKD: Are They Safe. Am J Kidney Dis. 2020 May 30; PubMed PMID: 32479922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - NSAIDs in CKD: Are They Safe? AU - Baker,Megan, AU - Perazella,Mark A, Y1 - 2020/05/30/ PY - 2020/01/02/received PY - 2020/03/18/accepted PY - 2020/6/2/pubmed PY - 2020/6/2/medline PY - 2020/6/2/entrez KW - CKD progression KW - Nonsteroidal anti-inflammatory drugs (NSAIDs) KW - acute kidney injury (AKI) KW - adverse effects KW - analgesic KW - chronic kidney disease (CKD) KW - chronic pain KW - drug safety KW - hyperkalemia KW - hypervolemia KW - hyponatremia KW - nephrotoxicity KW - pain management KW - renal dysfunction KW - review JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. N2 - The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have increased susceptibility to adverse drug effects due to altered drug metabolism and excretion, and there are limited safety data for use in this population despite a high pain burden. Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been regarded as dangerous for use in patients with CKD because of their risk for nephrotoxicity and thus alternative classes of analgesics, including opioids, have become more commonly used for pain control in this population. Given the well-established risks that opioids and other analgesics pose, further characterization of the risk posed by NSAIDs in patients with CKD is warranted. NSAID use has been associated with acute kidney injury, progressive loss of glomerular filtration rate in CKD, electrolyte derangements, and hypervolemia with worsening of heart failure and hypertension. The risk for these nephrotoxicity syndromes is modified by many comorbid conditions, risk factors, and characteristics of use, and in patients with CKD, the risk differs between levels of glomerular filtration rate. In this review, we offer recommendations for the cautious use of NSAIDs in the CKD population after careful consideration of these risk factors on an individualized basis. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/32479922/NSAIDs_in_CKD:_Are_They_Safe L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(20)30724-1 DB - PRIME DP - Unbound Medicine ER -
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