Nonsteroidal anti-inflammatory drug use and acute kidney injury in nephrectomies: A retrospective propensity score-matched cohort study.

Abstract

Introduction: Nonsteroidal anti-inflammatory drugs (NSAID) are analgesic and spare opioids, but it remains unclear whether perioperative NSAID use worsens renal function after nephrectomy. We therefore tested the hypothesis that perioperative use of NSAID is associated with acute kidney injury (AKI) after nephrectomy surgery.

Methods: This retrospective cohort study included patients ≥18 years old who had partial or radical nephrectomies. Patients who were given intravenous NSAIDs for postoperative analgesia were defined as one group, whereas reference patients did not use any NSAIDs. The primary outcome was the occurrence of postoperative acute kidney injury (AKI), as defined by the Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes included AKI stage, NSAID-related side effects, postoperative hemoglobin, cumulative opioid consumption, and duration of hospitalization.

Results: Among 3,359 eligible nephrectomy patients, 78% (2,614) were given NSAIDs. We propensity-score-matched 739 pairs of patients who were or were not given NSAIDs. Patients in the NSAID group did not have more AKI (27.6%vs. 27.9%, HR 0.98 95% CI (0.80-1.19), P =  0.90), nor were their AKI stages worse [OR 0.99 (0.79-1.24), P =  0.91]. No significant differences were detected in NSAID-related side effects [OR 1.50 (0.42, 5.32), P = 0.53]. However, NSAID treatment was associated with shorter postoperative hospitalization: [5,4,7] vs. [6,5,7] days, P < 0.001].

Conclusions: Perioperative use of NSAIDs in patients having nephrectomies was not associated with a greater risk of AKI, and possibly reduced the duration of hospitalization. Prospective interventional data are needed to guide NSAID use in this high-risk patient subset.