Kidney damage from nonsteroidal anti‐inflammatory drugs—Myth or truth? Review of selected literature

Drożdżal, Sylwester; Lechowicz, Kacper; Szostak, Bartosz; Rosik, Jakub; Kotfis, Katarzyna; Machoy-Mokrzyńska, Anna; Białecka, Monika; Ciechanowski, Kazimierz; Gawrońska-Szklarz, B

doi:10.1002/prp2.817

Cited by 44 publications

(34 citation statements)

References 50 publications

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“…The inhibition of cyclooxygenases, such as COX-1 and COX2, by NSAIDs also results in high blood pressure and sodium retention. Moreover, TIN can be caused by glomerular basement membrane damage, reduction in pore size, and podocyte density due to the use of NSAIDs [ 29 ]. A meta-analysis found that cyclooxygenase-2 (COX-2) inhibitors and traditional NSAIDs, except naproxen, increased the risk of serious CV events and death [ 30 ].…”

Section: Reviewmentioning

confidence: 99%

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients

Lee¹,

Santosa²,

Khor³

et al. 2023

Cureus

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Gout is the most common type of inflammatory arthritis, and its impact on cardiovascular health and quality of life is often underestimated. The prevalence and incidence of gout are increasing globally. Further, ischemic heart disease (IHD) and chronic kidney disease (CKD) are prevalent in gout patients. Some unmet needs for gout management include physicians' low initiation rate of urate-lowering therapy (ULT) and poor treatment adherence in patients with gout. There is also a lack of randomized controlled trials that establish safe doses of acute and long-term treatment for gout, particularly in patients with IHD and stage 4 CKD and above (including end-stage renal failure). Furthermore, there is also a lack of studies showing optimal serum uric acid (SUA) target and validated clinical outcome measures, including disease activity and remission criteria for gout tailored to treat-to-target approaches and the high cost of newer gout medications. The causal relationship between asymptomatic hyperuricemia or gout with comorbidities such as IHD and CKD has yet to be fully elucidated. There is a pressing need for collaborative international efforts to address the overall suboptimal management of gout.

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Section: Reviewmentioning

confidence: 99%

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients

Lee¹,

Santosa²,

Khor³

et al. 2023

Cureus

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“…Other effects of COX inhibition that influence the cardiovascular system include blood pressure regulation and kidney function. COX inhibitors may induce acute kidney injury, tubulo‐interstitial nephritis, and chronic kidney disease [20]. They prevent the synthesis of PGE 2 and PGI 2 , which increase renal blood flow and glomerular filtration under conditions with decreased circulating volume and decreased renal perfusion [21].…”

Section: (Patho)physiology Of Coxs and Arachidonic Acid Metabolitesmentioning

confidence: 99%

Lessons from 20 years with COX‐2 inhibitors: Importance of dose–response considerations and fair play in comparative trials

Stiller

Hjemdahl

2022

J Intern Med

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Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the enzyme cyclooxygenase (COX), which forms prostaglandins involved in pain and inflammation. COX inhibitors have analgesic and antiinflammatory effects, but also increase risks for gastrointestinal ulcers, bleeding, and renal and cardiovascular adverse events. Identification of two isoforms of COX, COX-1 and COX-2, led to the development of selective COX-2 inhibitors, which were launched as having fewer gastrointestinal side effects since gastroprotective prostaglandins produced via COX-1 are spared. The balance between COX-1 mediated prothrombotic thromboxane and COX-2 mediated antithrombotic prostacyclin is important for thrombotic risk. An increased risk of suffering myocardial infarction and death with COX-2 inhibitor treatment is well established from clinical trials and observational research. Rofecoxib (Vioxx) was withdrawn from the market for this reason, but the equally COX-2 selective etoricoxib has replaced it in Europe but not in the United States. The "traditional" NSAID diclofenac is as COX-2 selective as celecoxib and increases cardiovascular risk dose dependently. COX inhibitor dosages should be lower in osteoarthritis than in rheumatoid arthritis. Randomized trials comparing COX-2 inhibitors with NSAIDs have exaggerated their gastrointestinal benefits by using maximal NSAID doses regardless of indication, and/or hidden the cardiovascular risk by comparing with COX-2 selective diclofenac instead of lowdose ibuprofen or naproxen. Observational studies show increased cardiovascular risks within weeks of treatment with COX-2 inhibitors and high doses of NSAIDs other than naproxen, which is the safest alternative. COX inhibitors are symptomatic drugs that should be used intermittently at the lowest effective dosage, especially among individuals with an increased cardiovascular risk.

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“…The risk is most pronounced in the elderly, those concurrently taking ACE inhibitors or angiotensin-II receptor blockers, and/or diuretics. Individuals with renal dysfunction should use NSAIDs only with great caution under close clinical supervision, if at all [ 22 ].…”

Section: Reviewmentioning

confidence: 99%

New Insights Into the Pharmacological Management of Postoperative Pain: A Narrative Review

Rojals¹,

Charaja²,

Casasola³

et al. 2022

Cureus

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Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat. Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and, in some cases, opioids. NSAIDs are a broad class of drugs with different attributes such as cyclo-oxygenase (COX)-1 or COX-2 selectivity, onset of action, and analgesic potency. NSAIDs are associated with gastrointestinal and cardiovascular side effects and should be administered at the lowest effective dose for the shortest effective duration but can be effective in postoperative pain. The role of opioids in postoperative analgesia is long-standing but has recently come under scrutiny. Opioids are often used in multimodal analgesic combinations in such a way as to minimize the total consumption of opioids without sacrificing analgesic benefit. Special clinical considerations are required for surgical patients already on opioid regimens or with opioid use disorder. A particularly useful fixed-dose combination product for postoperative analgesia is dexketoprofen-tramadol, which confers safe and effective postoperative pain control and reduces the risk of persistent postoperative pain.

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Kidney damage from nonsteroidal anti‐inflammatory drugs—Myth or truth? Review of selected literature

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 44 publications

References 50 publications

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients

Lessons from 20 years with COX‐2 inhibitors: Importance of dose–response considerations and fair play in comparative trials

New Insights Into the Pharmacological Management of Postoperative Pain: A Narrative Review

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