Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: COMMENTARY.

Abstract

The debate in this issue of Kidney360 addresses the quandary that exists regarding the safety of nonsteroidal anti-inflammatory drug (NSAID) use in patients with CKD. This is an important issue because pain syndromes are common in patients with CKD. Whereas NSAIDs are a widely used and effective analgesic, they can be associated with several adverse clinical kidney syndromes (Table 1), particularly in patients with underlying CKD (1,2). Clinicians struggle to achieve adequate analgesia while also avoiding toxicity in this group. However, is avoiding NSAIDs in patients with CKD too restrictive and unnecessary? Our two expert debaters Erin Baretto and Bruce Guthrie tackle the conundrum of whether NSAIDs can be safely used in patients with nondialysis CKD. They will present the PRO and CON sides of the debate. We provide background on NSAID therapy in patients with CKD to set the stage for the debate. View this table: Table 1. Clinical kidney syndromes of nonsteroidal anti-inflammatory drugs Pain management in patients with CKD is limited by a number of analgesic drug-related adverse effects (3). Reduced GFR and impaired tubular secretion put patients with AKI or CKD at increased risk of drug-related nephrotoxicity because of increased accumulation of parent drugs, and their metabolites, from impaired metabolism and excretion (4). A significant number of drugs with potential toxicity are concomitantly prescribed to patients with advanced CKD (5). As such, NSAIDs are considered a class of drugs that should be avoided in patients with CKD, particularly those with advanced CKD (6,7). This approach has led to increased opioid administration and …