ACETAMINOPHEN AND ADVERSE CHRONIC RENAL OUTCOMES - AN APPRAISAL OF THE EPIDEMIOLOGIC EVIDENCE

This article critically reviews existing epidemiologic studies of the association between habitual acetaminophen use and chronic renal disea se exclusive of neoplasia, Relevant primary studies were identified by searching the Medline database from 1996 to March 1995. There are sev eral case reports of analgesic nephropathy following exposure to aceta minophen alone, but the accuracy with which other causes of this lesio n were excluded is unclear, Three case control studies have found an i ncreased risk (odds ratio range, 2 to 4) with habitual acetaminophen e xposure for papillary necrosis, chronic renal failure, or end-stage re nal disease, These studies have been open to confounding by indication . It is also difficult to determine the risk with acetaminophen alone given the prevalent use of analgesic mixtures in the populations studi ed. Two prospective cohort studies have suggested an increased risk of renal impairment or papillary calcification following regular analges ic exposure, One of these studies was of subjects taking phenacetin-co ntaining analgesic mixtures and the study population of the other was too small to reach statistically significant conclusions, Recent study results have raised the possibility that habitual acetaminophen use c ould increase the likelihood or rate of progression of chronic renal d isease in general, This review suggests that there is currently insuff icient evidence to conclude that habitual use of acetaminophen as a so le analgesic is associated with an increased risk of chronic renal dis ease. Further research is required to examine this question, prudence suggests that habitual use of acetaminophen should be discouraged in t he absence of strong medical indications. (C) 1996 by the National Kid ney foundation, Inc.