Inpatient NSAID Exposure and Development of Acute Kidney Injury in Medical Inpatients: A Retrospective Cohort Study

Area of Science:

• Nephrology
• Pharmacology
• Hospital Medicine

Background:

• Hospital-acquired acute kidney injury (AKI) is a significant concern in hospitalized patients.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management but carry potential renal risks.
• Assessing NSAID safety in diverse patient populations is crucial for optimizing care.

Purpose of the Study:

• To evaluate the association between NSAID administration and the risk of hospital-acquired AKI in general medical patients.
• To compare AKI rates across different NSAID exposure categories: no NSAID, low-dose aspirin, topical NSAIDs, and systemic NSAIDs.

Main Methods:

• Retrospective cohort study at an academic medical center including general care medical patients over two years.
• Propensity score adjustment using inverse probability of treatment weighting (IPTW) to control for confounding factors.
• Categorization of patients based on NSAID exposure on hospital days 0 or 1.

Main Results:

• 11,840 patients were included in the analysis.
• After IPTW adjustment, no statistically significant difference in AKI rates was observed between NSAID exposure groups and the no NSAID group.
• Adjusted AKI incidence ranged from 2.2% (topical NSAIDs) to 3.9% (low-dose aspirin), with no significant increase compared to the 3.4% in the no NSAID group.

Conclusions:

• Carefully selected hospitalized patients may tolerate NSAIDs without an elevated risk of AKI.
• This finding supports the use of NSAIDs as an alternative for pain management, potentially reducing opioid-related complications.
• Further prospective studies are warranted to confirm these results and guide clinical practice.