Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies
Abstract
Background The association between acute kidney injury (AKI) and use of non-steroidal anti-inflammatory drugs (NSAIDs) is well established. However, little is known about the comparative risk of individual NSAIDs, including specific COX-2 inhibitors. Methods We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio or standardized incidence ratio with 95% confidence comparing AKI risk in NSAID users versus non-users. Pooled risk ratios and 95% confidence intervals for individual NSAIDs were calculated using random-effect, generic inverse variance methods. Results Five studies were identified and included in our data analysis. Pooled risk ratios were calculated for seven traditional NSAIDs and two specific COX-2 inhibitors, including indomethacin, piroxicam, ibuprofen, naproxen, sulindac, diclofenac, meloxicam, rofecoxib and celecoxib that were evaluated in at least two studies. Our meta-analysis was able to demonstrate a statistically significant elevated AKI risk among most of the included traditional NSAIDs. The pooled risk ratios were fairly consistent among individual traditional NSAIDs, ranging from 1.58 to 2.11. Differences between pooled risk ratios did not reach statistical significance (p≥0.19 for each comparison). Elevated AKI risk was also observed in diclofenac, meloxicam, rofecoxib and celecoxib users, although did not achieve a statistical significance. Conclusion A statistically significant elevated AKI risk among traditional NSAID users has been demonstrated in this meta-analysis. The pooled risk ratios among individual traditional NSAIDs were not significantly different. The pooled risk ratios of specific COX-2 inhibitors and the two traditional NSAIDs with the most COX-2 selectivity (diclofenac and meloxicam) were also comparable with other traditional NSAIDs even though they did not achieve a statistical significance.
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The inference that acute inflammation usually has positive effects is strongly supported by findings that inhibiting the inflammatory response by nonsteroidal anti-inflammatory drugs worsens wound and bone healing, increases the risk of anastomotic failure or sepsis after surgery, aggravates heart and renal failure, interferes with an adequate immune response to antigen presentation in the gut, or
“The inference that acute inflammation usually has positive effects is strongly supported by the finding that inhibiting the inflammatory response by nonsteroidal anti‐inflammatory drugs worsens wound and bone healing,47, 48, 49, 50 increases the risk of anastomotic failure or sepsis after surgery,51, 52 aggravates heart and renal failure,53, 54 interferes with an adequate immune response to”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [53]
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- Authors
- Ungprasert, P., Cheungpasitporn, W., Crowson, C. S., & Matteson, E. L.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Ungprasert, Patompong
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 26
- Issue
- 4
- Pages
- 285-291
- ISSN
- 0953-6205 (ISSN-L)
- OpenAlex
- W2121944063
- Cited by
- 322
- References
- 40
- Citations by year
- 2026: 15 · 2025: 27 · 2024: 33 · 2023: 22 · 2022: 39 · 2021: 42 · 2020: 40 · 2019: 38 · 2018: 21 · 2017: 23 · 2016: 17 · 2015: 5
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Nephrotoxicity and Medicinal Plants
- Keywords
- acute kidney injury, nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, diclofenac, meloxicam, rofecoxib, celecoxib, ibuprofen, naproxen, piroxicam, sulindac, indomethacin, drug-induced nephrotoxicity
- MeSH terms
- Anti-Inflammatory Agents, Non-Steroidal, Humans, Risk Factors, Odds Ratio, Cyclooxygenase 2 Inhibitors, Acute Kidney Injury, Observational Studies as Topic
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