Excess Risk for Kidney Disease in Young Military Personnel Who Use NSAIDs

June 24, 2019 by Dr. Clemens Leave a Comment

Authors: Nelson DA et al.

JAMA Net Open 2019 Feb 15

Frequent use of nonsteroidal anti-inflammatory drugs was associated with ≈50 more kidney disease cases per 100,000 people annually.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with kidney disease in older patients. In this retrospective cohort study, researchers explored the health effects of NSAIDs in 760,000 young and middle-aged active-duty U.S. Army personnel (mean age, 29; 86% men) without known kidney disease. Units of NSAIDs taken by participants (mostly ibuprofen and naproxen) were converted to defined daily doses (DDDs) per month. In the 6 months prior to baseline, 18% of the cohort used one to seven DDDs, and 16% of the cohort used more than seven. Researchers controlled for demographic and clinical factors, including history of rhabdomyolysis and obesity.

During roughly 2 years of follow-up, 0.3% and 0.2% of the cohort experienced incident acute and chronic kidney disease, respectively. Among those who used more than seven DDDs, researchers found a small but statistically significant number of excess cases of acute and chronic kidney diseases (≈18 and ≈30 excess annual cases per 100,000 exposed people, respectively; hazard ratios, 1.2 for each diagnosis).

COMMENT

Chronic NSAID use is not benign, even in healthy young people. This population might have been at higher risk than a typical civilian population due to extreme physical activity and concomitant dehydration. I have seen at least two patients in their 40s whose renal failure and subsequent need for dialysis and transplant were thought to be due to chronic NSAID use associated with recreational sports.

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