Cited by 484Nephrotoxicity and Medicinal PlantsInflammatory mediators and NSAID effectsAcute Kidney Injury Research

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Risk of Kidney Failure Associated with the Use of Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs

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Perneger, Thomas V., Whelton, Paul K., Klag, Michael J.·1994·New England Journal of Medicine

DOI 10.1056/nejm199412223312502

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Abstract

BACKGROUND: People who take analgesic drugs frequently may be at increased risk of end-stage renal disease (ESRD), but the extent of this risk remains unclear. METHODS: We studied 716 patients treated for ESRD and 361 control subjects of similar age from Maryland, Virginia, West Virginia, and Washington, D.C. The study participants were interviewed by telephone about their past use of medications containing acetaminophen, aspirin, and other nonsteroidal antiinflammatory drugs (NSAIDs). For each analgesic drug, the average use (in pills per year) and the cumulative intake (in pills) were examined for any association with ESRD. RESULTS: Heavier acetaminophen use was associated with an increased risk of ESRD in a dose-dependent fashion. When persons who took an average of 0 to 104 pills per year were used for reference, the odds ratio of ESRD was 1.4 (95 percent confidence interval, 0.8 to 2.4) for those who took 105 to 365 pills per year and 2.1 (95 percent confidence interval, 1.1 to 3.7) for those who took 366 or more pills per year, after adjustment for race, sex, age, and intake of other analgesic drugs. When persons who had taken fewer than 1000 pills containing acetaminophen in their lifetime were used for reference, the odds ratio was 2.0 (95 percent confidence interval, 1.3 to 3.2) for those who had taken 1000 to 4999 pills and 2.4 (95 percent confidence interval, 1.2 to 4.8) for those who had taken 5000 or more pills. Approximately 8 to 10 percent of the overall incidence of ESRD was attributable to acetaminophen use. A cumulative dose of 5000 or more pills containing NSAIDs was also associated with an increased odds of ESRD (odds ratio, 8.8), but the use of aspirin was not. CONCLUSIONS: People who often take acetaminophen or NSAIDs have an increased risk of ESRD, but not those who often take aspirin.

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Additional file 5 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943681
Additional file 3 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943675
Additional file 1 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943669
Additional file 2 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943672
Additional file 4 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943678
Additional file 6 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943684
Additional file 7 of NSAIDs, analgesics, antiplatelet drugs, and decline in renal function: a retrospective case-control study with SIDIAP database
Monné, S. B., Urgell, C. V., Sáez, M. J. P., Cunillera, O., Diez, J. M. B., Pascual, J., Lago, C., Ruiz, J. R., Gonzalez, B. S., & Pedrós, R. M. (2024) · Figshare · doi:10.6084/m9.figshare.26943687
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Authors: Perneger, T. V., Whelton, P. K., & Klag, M. J.
Affiliations: University of Geneva (CH)
Johns Hopkins University (US)
ORCID: Perneger, Thomas V.
Whelton, Paul K.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1994-12-22
Volume: 331
Issue: 25
Pages: 1675-1679
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199412223312502
OpenAlex: W2320758398
Cited by: 484
References: 15
Citations by year: 2026: 3 · 2025: 5 · 2024: 18 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 21 · 2019: 19 · 2018: 11 · 2017: 10 · 2016: 16 · 2015: 17 · 2014: 17 · 2013: 20 · 2012: 20
FWCI: 20.58
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (R03-HS06978-01)
National Center for Research Resources (5MOIRR00722, RR 00035)
Topics: Health Sciences › Medicine › Nephrology › Nephrotoxicity and Medicinal Plants
Health Sciences › Medicine › Pharmacology (medical) › Inflammatory mediators and NSAID effects
Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords: end-stage renal disease, renal failure, paracetamol, aspirin, nonsteroidal anti-inflammatory drugs, analgesic use, dose-response relationship, attributable risk, drug-induced nephrotoxicity
MeSH terms: Acetaminophen, Adult, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Drug Utilization, Female, Humans, Kidney Failure, Chronic, Male, Middle Aged, Risk Factors, Causality, Confidence Intervals, Odds Ratio, Case-Control Studies

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Risk of Kidney Failure Associated with the Use of Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs

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