Reduced Dose Perioperative Non-Steroidal Anti-Inflammatory Drugs in Arthroplasty Patients With Renal Impairment: A Five-Year Cohort Study.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are fundamental for multimodal analgesic therapy, but are traditionally avoided in renally impaired patients. We aim to show NSAIDs can be safely administered to arthroplasty patients with a pre-operative estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² without causing a permanent reduction in post-operative eGFR and, in doing so, minimise opioid use.

Methods: We prospectively collected data from patients with a pre-operative eGFR less than 60 mL/min/1.73 m² undergoing arthroplasty between January 2018 and June 2023 at St John of God Ballarat Hospital, Australia. Baseline eGFR was obtained pre-operatively, and on at least 1 of days 1, 2, 10, or a follow-up review appointment of at least 4 weeks. Patients received tailored dosing of perioperative NSAIDs corresponding to pre-operative eGFR. Acute kidney injury (AKI) was defined using the RIFLE criteria.

Results: We identified 221 patients. Median baseline eGFR was 50 mL/min/1.73 m² and median eGFR recovery at latest follow-up was 109% of baseline eGFR. 28% of the cohort had a clinically significant reduction in eGFR on day 1 post-operatively, and by latest follow-up, this subgroup had a median recovery of 106% of baseline eGFR. At the 2-week follow-up, there were no cases of AKI, and by latest follow-up, no patients had a clinically significant reduction of baseline eGFR.

Conclusion: Perioperative NSAIDs in renally impaired patients undergoing arthroplasty surgery can be safely given using an adjusted dose protocol based on pre-operative renal function. Future studies investigating the circumspect use of NSAIDs for pain management during arthroplasty are warranted.