Incidence of kidney toxicity of non-steroidal anti-inflammatory drugs in critically ill patients.

BACKGROUND

Analgesia is paramount to improving critically ill patients recovery and preventing complications, especially during the post-operative time. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide cost-effective analgesia but also carry risks, including gastrointestinal bleeding and acute kidney injury (AKI). Their safety in this setting is poorly understood.

METHODS

All patients admitted to the Hospital Vila Franca de Xira ICU for more than 24 h, from January 1st 2015, to December 31st 2023, were included. Acute kidney injury was tracked throughout the ICU and hospital stay for all included patients, using the serum creatinine and urine output. Patients already with kidney dysfunction on admission to the ICU, either chronic or acute, were excluded. Short- and long-term outcomes (until 2 years of follow-up) were retrieved.

RESULTS

The study included 1157 patients. NSAIDs were more commonly used among surgical patients (62. in non-scheduled and 61. in scheduled surgery) than medical patients (23., p < 0.001). Its use was associated with higher AKI rates (67. vs. 51., p = 0.009), including severe AKI (stage 3, 34. vs. 26., p = 0.008). Notably, while non-severe AKI had no significant impact on 2-year survival, severe AKI was associated with significantly worse survival (adjusted hazard ratio 1.42, confidence interval 1.09-1.86, p = 0.011). Recovery of renal function did not significantly decrease the long-term survival (80. vs. 78., log-rank test, p = 0.636).

CONCLUSION

In critically ill patients, the use of NSAIDs is associated with AKI and may lead to a worse prognosis.