Renal safety of postoperative short-term use of flurbiprofen axetil in well-controlled hypertensive patients: a prospective multicenter cohort study.

BACKGROUND

Currently, postoperative nonsteroidal anti-inflammatory drugs-associated kidney damage in hypertensive patients remains undetermined. This study aimed to examine renal safety of short-term post-surgery use of flurbiprofen axetil (FA) in well-controlled hypertensive patients.

METHODS

Data were collected from January 2020 to March 2021 at four major hospitals on patients who had undergone total knee replacement surgery (TKA). Patients were divided into well-controlled hypertensive and normotensive groups, and received short-term intravenous FA postoperatively. The primary outcomes were trajectory changes of postoperative renal injury biomarkers. Second outcomes included acute kidney injury (AKI), pain intensity and other complications.

RESULTS

A total of 120 patients were enrolled. Post-surgery FA significantly reduced pain in both groups. The results of repeated measures analysis of variance (ANOVA) demonstrated that the main effects of group, time and the group-by-time interaction on blood urea nitrogen (BUN), serum creatine (SCr) and Cystatin C (Cys C) levels were not statistically significant on postoperative day 2 and 5 (POD2 and POD5) (all P > 0.05). Urine N-acetyl-beta-glucosaminidase (NAG) levels were significantly higher on POD2 and POD5 in both groups [preoperative: (6.66 ± 4.87) U/L, POD2: (10.07 ± 6.88) U/L, POD5: (10.25 ± 7.68) U/L in normotensive group; preoperative: (7.39 ± 4.07) U/L, POD2: (12.34 ± 7.1) U/L, POD5: (15.57 ± 12.34) U/L in well-controlled hypertensive group; all P < 0.001] compared with baseline. However, only the well-controlled hypertensive group showed a continued increase in NAG levels on POD5 (P = 0.039). AKI occurred in 7.0% (4/57) and 3.2% (2/63) of well-controlled hypertensive and normotensive patients (P = 0.335), and all the AKI patients were at stage 1. After adjusting for confounding factors, hypertension had no impact on AKI (OR = 0.733, 95%CI: 0.074-7.222, P = 0.790). No significant differences in other complications were observed between the groups.

CONCLUSION

The current FA regimen after surgery is effective, and it does not increase AKI incidence in well-controlled hypertensive TKA patients, thought posing a risk of tubular damage.