Survey of Australasian Renal and Rheumatology Specialists investigating topical NSAID use and adverse renal outcomes.

Abstract

A survey investigated physician reported use, prescribing practices and adverse renal events of topical NSAIDs. This survey was sent to members of the Australian Rheumatology Association and the Australian and New Zealand Society of Nephrology. Sixty physicians responded, 55% (n = 33) were nephrologists; 45% (n = 27) rheumatologists. Nearly all (n = 56, 93.3%) had managed at least one patient using topical NSAIDs, including those with an eGFR <45 mL/min (n = 55, 91.7%). Concern was expressed that patients may use topical NSAIDs without the physician's knowledge. The majority (n = 40, 66.6%) have prescribed (or recommended) a topical NSAID, slightly less in patients with a reduced eGFR <45 mL/min (n = 36, 60.0%). Participants would advise topical NSAIDs for osteoarthritis and musculoskeletal pain, though be mindful to monitor the renal function and blood pressure. There was a variance in comments in advising use in CKD (eGFR <45 mL/min) from avoidance in those with an eGFR <30 mL/min to minimal concern. Most respondents (n = 55, 91.7%) had not encountered an acute kidney injury (AKI) suspected from topical NSAID use. Of the five that did, three were thought to be an adverse renovascular event and two were uncertain. All patients had an eGFR <45 mL/min, all had recovery f their renal function with NSAID cessation. Patients commonly use topical NSAIDs, often without the physician's knowledge. Most respondents would recommend their use in osteoarthritis and musculoskeletal pain, though with caution in CKD. While an AKI is uncommon due to topical NSAIDs, it may occur, especially in those with CKD.