Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Mar 31;63(1):3-27.
doi: 10.2478/rjim-2024-0029. eCollection 2025 Mar 1.

Non-steroidal anti-inflammatory drugs: what is the actual risk of chronic kidney disease? A systematic review and meta-analysis

Saeed Soliman  1 , Rabab Mahmoud Ahmed  2 , Marwa Mostafa Ahmed  3 , Abeer Attia  4 , Amin Roshdy Soliman  5
Affiliations
Free article
Meta-Analysis

Non-steroidal anti-inflammatory drugs: what is the actual risk of chronic kidney disease? A systematic review and meta-analysis

Saeed Soliman et al. Rom J Intern Med. .
Free article

Abstract
in English, Romanian

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are common cause of acute kidney injury, but chronic kidney disease (CKD) risk of NSAIDs is controversial. Prior systematic reviews are outdated with some methodological flaws. We conducted this systematic review to clarify the association between chronic NSAIDs use and occurrence and/or progression of CKD.

Methods: MEDLINE, Cochrane Library, Web of Science and Science direct were searched for observational and interventional studies from inception to May 2023. Qualitative synthesis was performed. The meta-analysis used pooled odds ratios (OR) and hazard ratios (HR) to estimate the association between chronic NSAID use and CKD occurrence or progression.

Results: Forty studies with a total of 1757118 participants were included in the systematic review; of them 39 studies were suitable for meta-analysis. 56% of our included studies were recent, published within the last 10 years. The meta-analysis revealed a significant association between chronic NSAIDs use and CKD occurrence and progression. The pooled odds ratio was 1.24 (95% CI: 1.11-1.39, p <0.001, I2 = 91.21%), and the pooled hazard ratio was 1.50 (95% CI: 1.31-1.7, p <0.001, I² = 90.77%). The pooled hazard ratio (HR) for individuals with no CKD at baseline was 1.31 (95% CI, 1.26-1.40), while for those with preexisting CKD, the HR was significantly higher at 1.67 (95% CI, 1.38-2.02). The HR for individuals with no specific chronic disease was 1.6 (95% CI, 1.32-1.94). For populations with diabetes mellitus (DM) and/or hypertension (HTN), the HR was 1.35 (95% CI, 1.27-1.43), and for those with rheumatic disease, the HR was 1.36 (95% CI, 0.88-2.10).

Conclusions: Long-term NSAID use increases the risk of chronic kidney disease (CKD) occurrence and progression, especially in individuals with pre-existing CKD, who have a 67% risk compared to the general population's 60%. A patient-centered approach for safe and effective pain management is crucial, with special caution for those with pre-existing CKD.

Introducere: Medicamentele antiinflamatorii nesteroidiene (AINS) sunt o cauză frecventă a leziunilor renale acute, dar riscul de boală renală cronică (CKD) dat de AINS este controversat. Sintezele sistematice anterioare sunt depășite cu unele deficiențe metodologice. Am efectuat această sinteză sistematică pentru a clarifica asocierea dintre utilizarea și apariția și/sau progresia CKD.

Metode: Medline, Cochrane Library, Web of Science și Science Direct Direct au fost căutate pentru studii observaționale și intervenționale de la începutul indexării până în mai 2023. S-a efectuat sinteză calitativă. Meta-analiza a utilizat raportul cotelor (OR) și raportul hazardului (HR) pentru a estima asocierea dintre utilizarea cronică a AINS și apariția sau progresia CKD.

Rezultate: Patruzeci de studii cu un total de 1757118 participanți au fost incluse în sinteza sistematică; dintre ele, 39 de studii au fost potrivite pentru meta-analiză. 56% din studiile noastre incluse au fost recente, publicate în ultimii 10 ani. Metaanaliza a evidențiat o asociere semnificativă între utilizarea cronică a AINS și apariția și progresia CKD. OR combinat a fost de 1,24 (IC 95%: 1,11–1,39, p <0,001, I² = 91,21%), iar HR combinat a fost de 1,50 (IC 95%: 1,31–1,7, p <0,001, I² = 90,77%). HR pentru persoanele fără CKD inițial a fost de 1,31 (IC 95%, 1,26–1,40), în timp ce pentru cei cu CKD preexistent, HR-ul a fost semnificativ mai mare la 1,67 (IC 95%, 1,38–2,02). HR-ul pentru persoanele fără boală cronică specifică a fost de 1,6 (IC 95%, 1,32–1,94). Pentru populațiile cu diabet zaharat (DM) și/sau hipertensiune arterială (HTN), HR-ul a fost de 1,35 (IC 95%, 1,27–1,43), iar pentru cei cu boală reumatică, HR-ul a fost de 1,36 (IC 95%, 0,88–2,10).

Concluzii: Utilizarea AINS pe termen lung crește riscul de apariție și progresie a bolilor renale cronice (CKD), în special la persoanele cu CKD preexistente, care au un risc de 67% în comparație cu 60% din populația generală. O abordare centrată pe pacient pentru o gestionare sigură și eficientă a durerii este crucială, cu precauție specială pentru cei cu CKD preexistent.

Keywords: Non-steroidal anti-inflammatory drugs; analgesics; chronic kidney disease; pain; renal disease.

PubMed Disclaimer

References

    1. COXIB AND TRADITIONAL NSAID TRIALISTS’ (CNT) COLLABORATION. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet. 2013; 382:769–79.
    1. REENA DOOMRA AND ANJANA GOYAL. NSAIDs and self-medication: A serious concern. J Family Med Prim Care. 2020 May; 9(5): 2183–2185.
    1. FARAH RI, KHATIB AE, ABU ZIYAD HJ, JIAD DK, AL QUSOUS LR, ABABNEH AJ, et al . Pattern of use and awareness of side-effects of non-steroidal anti-inflammatory drugs in the Jordanian population. Annals of Medicine. 2023 Dec 12;55(2):2242248.
    1. KOVESDY CP. Epidemiology of chronic kidney disease: an update 2022. Kidney international supplements. 2022 Apr 1;12(1):7–11.
    1. PATINO FG, OLIVIERI J, ALLISON JJ, MIKULS TR, MORELAND L, KOVAC SH, et al . Nonsteroidal antiinflammatory drug toxicity monitoring and safety practices. The Journal of Rheumatology. 2003 Dec 1;30(12):2680–8.

MeSH terms

Substances

LinkOut - more resources