Literature review: are NSAIDs harmful and is acetaminophen well tolerated?

On the basis of previous literature, NSAID use is typically avoided in patients at risk for kidney disease, while acetaminophen has generally been considered well tolerated. However, the extent of NSAID effect on the kidneys is not clear, especially in chronic kidney disease (CKD), and the concerns about the safety of acetaminophen have been rising. In this review, we will discuss the latest evidence of the effects of NSAIDs and acetaminophen in the context of nephrology and hypertension.

The risk of acute kidney injury (AKI) by NSAIDs is higher with longer courses and in the presence of several factors such as older age, diabetes mellitus, lower eGFR, diuretic use and cardiovascular disease. The timing of NSAID use in relation to the onset of AKI may affect its progression. Regular NSAID use could be associated with an increased incidence of CKD, but the relation between NSAID use and CKD progression is less clear. Regular acetaminophen use was associated with increased SBP, while its use could have a renoprotective effect in certain situations.

In patients at risk of kidney disease, NSAIDs may be used cautiously after discussing possible adverse effects. Regular acetaminophen use should be reassessed in patients with uncontrolled hypertension.