Nonsteroidal antiinflammatory drugs and acute renal failure in elderly persons

Renal prostaglandin inhibition by nonsteroidal antiinflammatory drugs (NSAI Ds) may decrease renal function, especially under conditions of low effecti ve circulating volume. To evaluate the risk of important deterioration of r enal function due to this effect, the authors performed a nested case-contr ol study using Tennessee Medicaid enrollees aged greater than or equal to 6 5 years in 1987-1991. Cases were patients who had been hospitalized with co mmunity-acquired acute renal failure; they were selected on the basis of me dical record review of Medicaid enrollees with selected discharge diagnoses . Information on the timing, duration, and dose of prescription NSAIDs used , demographic factors, and comorbidity was gathered from computerized Medic aid-Medicare data files. Of the 1,799 patients with acute renal failure (4. 51 hospitalizations per 1,000 person-years), 18.1% were current users of pr escription NSAIDs as compared with 11.3% of 9,899 randomly selected populat ion controls. After control for demographic factors and comorbidity, use of NSAIDs increased the risk of acute renal failure 58% (adjusted odds ratio = 1.58; 95% confidence interval (CI): 1.34, 1.86). For ibuprofen, which acc ounted for 35% of NSAID use, odds ratios associated with dosages of less th an or equal to 1,200 mg/day, >1,200-<2,400 mg/day, and greater than or equa l to 2,400 mg/day were 0.94 (95% Cl: 0.58, 1.51), 1.89 (95% Cl: 1.34, 2.67) , and 2.32 (95% Cl: 1.45, 3.71), respectively (test for linear trend: p = 0 .009). Prescription NSAID use resulted in an estimated 25 excess hospitaliz ations associated with renal failure per 10,000 years of use. Thus, NSAIDs represent a relatively uncommon but avoidable cause of acute renal failure in frail elderly persons.