Most studies evaluating the nephrotoxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) have been conducted in elderly patients or patients with pre-existing renal disorders. A large study provides information on the nephrotoxicity of NSAIDs in young and healthy patients. It included 764 228 persons who served in the US military between 2011 and 2014, 86% of them male. The median age was 27 years. They were followed up until 2018.

The doses of prescribed NSAIDs given were calculated as defined daily doses over the previous 6 months. During this 6-month period, 16% of these army personnel received more than 42 defined daily doses of NSAIDs; 18% received 42 or less; and 66% did not receive a prescription for NSAIDs. Of the 804 471 ibuprofen prescriptions, 78% were for 800 mg unit doses 3 times or more per day in 88% of cases. Of the 376 078 naproxen prescriptions, 96% were for units of 500 mg or more, 94% two or more times per day.

In total, 3 per 1 000 military personnel had acute renal failure and 2 per 1 000 had chronic renal disease. Compared to individuals who had not received a prescription for NSAIDs, a statistically significant 20% greater risk of acute renal failure or chronic renal disease was observed in the group most exposed to NSAIDs. The authors of the study point to the risks associated with the intensive physical exertion and resulting dehydration experienced by soldiers during training in hot environments.

These data suggest that even young and healthy people should  be made aware of the harms associated with taking an NSAID when intense physical exercise is planned, especially in hot weather.

©Prescrire 1 December 2019

"NSAIDs: nephrotoxicity in young, healthy adults" Prescrire Int 2019; 28 (210): 298. (Pdf, subscribers only).

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