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. 2022 Nov 14;15(11):1409.
doi: 10.3390/ph15111409.

Acute Kidney Injury in a Cohort of Critical Illness Patients Exposed to Non-Steroidal Anti-Inflammatory Drugs

Henry Oliveros  1   2 , Giancarlo Buitrago  1   3
Affiliations

Acute Kidney Injury in a Cohort of Critical Illness Patients Exposed to Non-Steroidal Anti-Inflammatory Drugs

Henry Oliveros et al. Pharmaceuticals (Basel). .

Abstract

To determine whether non-steroidal anti-inflammatory drug (NSAIDs) exposure prior to intensive care unit (ICU) admission affects the development of acute kidney injury (AKI) with renal replacement therapy (RRT). An administrative database is used to establish a cohort of patients who were admitted to the ICU. The exposure to NSAIDs that the patients had before admission to the ICU is determined. Demographic variables, comorbidities, AKI diagnoses requiring RRT, and pneumonia during the ICU stay are also measured. Multivariate logistic regression and inverse probability weighting (IPW) are used to calculate risks of exposure to NSAIDs for patients with AKI requiring RRT. In total, 96,235 patients were admitted to the ICU, of which 16,068 (16.7%) were exposed to NSAIDs. The incidence of AKI with RRT was 2.71% for being exposed to NSAIDs versus 2.24% for those not exposed (p < 0.001). For the outcome of AKI, the odds ratio weighted with IPW was 1.28 (95% CI: 1.15−1.43), and for the outcome of pneumonia as a negative control, the odds ratio was 1.07 (95% CI: 0.98−1.17). The impact of prior exposure to NSAIDs over critically ill patients in the development of AKI is calculated as 8 patients per 1000 exposures. The negative control with the same sources of bias did not show an association with NSAID exposure.

Keywords: acute kidney injury (AKI); critical illness; negative control; nephrotoxicity; non-steroidal anti-inflammatory drugs.

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Conflict of interest statement

The authors of this manuscript have no competing interests directly related to the manuscript’s content.

Figures

Figure 1
Figure 1
Flowchart of subjects included based on administrative health data.
Figure 2
Figure 2
Causal pathway between NSAIDs and AKI and the relationship with confounding variables. C1: trauma, sepsis, myocardial infarct, congestive heart failure; C2: age, sex, hypertension, diabetes cerebrovascular disease, chronic pulmonary disease, peptic ulcer disease, liver disease; C3: liquid balance, hypotension, vasopressors.
Figure 3
Figure 3
Factors for the development of acute kidney injury.
See this image and copyright information in PMC

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