Effects of NSAIDs on Early CKD Development: A 10-Year Population-Based Study Using the Korean Senior Cohort.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management but are associated with nephrotoxicity, particularly in senior populations. While the acute nephrotoxicity of NSAIDs is well established, evidence on their long-term effects on renal function-particularly in community-dwelling older adults-has been mixed across studies.

Objectives: This study investigated the association between NSAID use and chronic kidney disease (CKD) risk in the general senior population.

Methods: Data from the National Health Insurance Service-Senior Cohort (NHIS-SC) in South Korea were analyzed, including 1812 participants (604 NSAID users and 1208 controls) matched 1:2 by propensity score. Kidney dysfunction was defined as glomerular filtration rate (eGFR) < 60 mL/min/1.73m² with a ≥ 10% decline from baseline. Hazard ratios (HRs) for CKD were estimated using Cox regression.

Results: NSAID use was associated with an increased CKD risk (HR 1.46; 95% confidence interval (CI) 1.11-1.93) and faster eGFR decline. Subgroup analysis showed elevated risks for Cox-1 (HR 1.53) and Cox-2 inhibitors (HR 1.61). End-stage renal disease (ESRD) incidence was rare and not significant.

Conclusions: NSAIDs increase CKD risk and accelerate kidney function decline in senior individuals. Cautious prescription and regular kidney monitoring are recommended, and further randomized trials are needed.