Nonsteroidal anti‐inflammatory drugs associated acute kidney injury in hospitalized children: A systematic review and meta‐analysis

Gong, Jun; Ma, Lei; Li, Mengya; Ma, Lulin; Chen, Chaoyang; Simiao, Zhao; Zhou, Ying; Chen, Yimin

doi:10.1002/pds.5385

Cited by 8 publications

(3 citation statements)

References 44 publications

(51 reference statements)

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“…Interestingly, the study also reported an increased incidence of AKI and/or hyperkalaemia in individuals using topical NSAIDs when compared with no NSAID use [9 & ], which is consistent with the findings of another retrospective study that showed an increased incidence of AKI in patients with CKD using topical NSAIDs when compared with no NSAID use [10]. In addition, a recent meta-analysis of observational studies examined the effect of NSAIDs on AKI in hospitalized paediatric patients, where a significantly increased AKI risk was seen [odds ratio (OR) 1.55, 95% confidence interval (95% CI) 1.26-1.92] [11].…”

supporting

confidence: 85%

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

Abbasi¹

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewOn 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. Recent findingsThe 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.

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supporting

confidence: 85%

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

Abbasi¹

2023

Current Opinion in Nephrology &Amp; Hypertension

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“…NSAIDs were reported to be correlated with an increased risk of AKI in the general population in both children and adults. The possible reasons were as follows: NSAIDs can reduce renal blood flow; and may cause tubular obstruction owing to crystal deposition then induce direct cytotoxicity and cell-mediated immune attack [ 25 , 26 ]. Among the published studies in which NSAIDs were mentioned, only one study found that patients with NSAIDs exposure had a higher incidence of ICIs-associated AKI [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of immune checkpoint inhibitor-associated acute kidney injury: evidence from clinical studies and FDA pharmacovigilance database

Chen

Zhu

et al. 2023

BMC Nephrol

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Background Several risk factors of immune checkpoint inhibitors (ICIs)-associated acute kidney injury (AKI) have been reported sporadically. To identify the risk factors of ICIs-associated AKI in a large-scale population, therefore we conducted a systematic review and a real-world retrospective study. Methods We search literature concerning risk factors of ICIs-associated AKI in ClinicalTrials.gov and electronic databases (PubMed, Cochrane Library, Embase) up to January 2022. Meta-analysis was performed by using odds ratios (ORs) with 95%CIs. In a separate retrospective pharmacovigilance study by extracting data from US FDA Adverse Event Reporting System (FAERS) database, disproportionality was analyzed using the reporting odds ratio (ROR). Results A total of 9 studies (5927 patients) were included in the meta-analysis. The following factors were associated with increased risk of ICIs-associated AKI, including proton pump inhibitors(PPIs) (OR = 2.07, 95%CI 1.78–2.42), angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs) (OR = 1.56, 95%CI 1.24–1.95), nonsteroidal anti-inflammatory drugs (NSAIDs) (OR = 1.29, 95%CI 1.01–1.65), diuretics (OR = 2.00, 95%CI 1.38–2.89), diabetes mellitus (OR = 1.28, 95%CI 1.04–1.57), genitourinary cancer (OR = 1.46, 95%CI 1.15–1.85), combination therapy of ICIs (OR = 1.93, 95%CI 1.25–2.97) and extrarenal immune-related adverse events(irAEs) (OR = 2.51, 95%CI 1.96–3.20). Furthermore, analysis from FAERS database verified that concurrent exposures of PPIs (ROR = 2.10, 95%CI 1.91–2.31), ACEIs/ARBs (ROR = 3.25, 95%CI 2.95–3.57), NSAIDs (ROR = 3.06, 95%CI 2.81–3.32) or diuretics (ROR = 2.82, 95%CI 2.50–3.19) were observed significant signals associated with AKI in ICIs-treated patients. Conclusions Concurrent exposures of PPIs, ACEIs/ARBs, NSAIDs or diuretics, diabetes mellitus, genitourinary cancer, combination therapy, and extrarenal irAEs seem to increase the risk of AKI in ICIs-treated patients.

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“…Although many pediatric guidelines suggest NSAIDs or paracetamol for pain, fever or inflammation in children ( Turner et al, 2018 ; Vittinghoff et al, 2018 ; Mitchell et al, 2019 ; Ozen et al, 2019 ; Pirelli et al, 2019 ; Ringold et al, 2019 ; Wahezi et al, 2020 ), they should be taken with caution due to the possibility of adverse reactions such as hypersensitivity reactions ( Kidon et al, 2018 ), renal damage ( Gong et al, 2021 ), and even kidney failure ( Gong et al, 2021 ; Bensman, 2019 ). However, the reporting of recommendations on NSAIDs in pediatric guidelines is inadequate, which is due to several reasons and may potentially lead to inappropriate drug use.…”

Section: Discussionmentioning

confidence: 99%

Recommendations on Off-Label Drug Use in Pediatric Guidelines

et al. 2022

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Objective: To systematically analyze the supporting evidence, drug information, and the type of off-label drug use in recommendations on off-label drug use in pediatric guidelines.Methods: A cross-sectional study was performed by systematic search through MEDLINE (via PubMed) and Embase databases to identify literature published from 1 January 2018, to 31 December 2020. Only pediatric clinical practice guidelines that included recommendations on off-label use of drugs were included. We present descriptive information on the sources of the included guidelines, country, publication year, evidence grading system used, details on the types of off-label drug use, and the types of studies used as references to support the recommendations.Results: A total of 66 pediatric guidelines with 605 recommendations were included. Eighty-seven (14.4%) recommendations did not cite any references; and the remaining 518 recommendations were supported by 2,240 references (mean 4.3 references/recommendation). The most common types of studies cited were pediatric RCTs (n = 314, 14.0%), pediatric case series studies (n = 260, 11.6%), and reviews (n = 255, 11.4%). Twenty-one percent (n = 470) of the references were studies on adults. One hundred and forty (23.1%) recommendations were graded using the Grading of Recommendations, Assessments, Development, and Evaluations (GRADE) system, of which 37 (26.4%) were graded as strong but supported with only C or D level of evidence. The most commonly reported type of information in the recommendations was indication (n = 499, 82.5%). The most commonly addressed type of off-label drug use in the 523 positive recommendations was unapproved population (n = 255, 48.8%). Sixty-nine (11.4%) recommendations explicitly reported the drug use as off-label.Conclusion: Children may be exposed to medical risks due to gaps in reporting and evidence of off-label drug use recommendations in pediatric guidelines.

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Nonsteroidal anti‐inflammatory drugs associated acute kidney injury in hospitalized children: A systematic review and meta‐analysis

Cited by 8 publications

References 44 publications

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

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

Risk factors of immune checkpoint inhibitor-associated acute kidney injury: evidence from clinical studies and FDA pharmacovigilance database

Recommendations on Off-Label Drug Use in Pediatric Guidelines

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