Lim Jung-Sun, Han Sujeong, Kim Jong Seung, Kim Sunyoung, Oh Bumjo
Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Family Medicine, SMG-SNU Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
Drugs Aging. 2025 Aug 6. doi: 10.1007/s40266-025-01239-9.
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.
This study investigated the association between NSAID use and chronic kidney disease (CKD) risk in the general senior population.
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/1.73m with a ≥ 10% decline from baseline. Hazard ratios (HRs) for CKD were estimated using Cox regression.
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.
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.
非甾体抗炎药（NSAIDs）广泛用于疼痛管理，但与肾毒性相关，尤其是在老年人群中。虽然NSAIDs的急性肾毒性已得到充分证实，但关于其对肾功能的长期影响——尤其是在社区居住的老年人中——的研究证据并不一致。
本研究调查了一般老年人群中使用NSAIDs与慢性肾脏病（CKD）风险之间的关联。
分析了韩国国民健康保险服务老年队列（NHIS-SC）的数据，包括1812名参与者（604名NSAIDs使用者和1208名对照），按倾向得分1:2匹配。肾功能不全定义为肾小球滤过率（eGFR）<60 mL/min/1.73m²，且较基线下降≥10%。使用Cox回归估计CKD的风险比（HRs）。
使用NSAIDs与CKD风险增加（HR 1.46；95%置信区间（CI）1.11-1.93）和eGFR更快下降相关。亚组分析显示Cox-1抑制剂（HR 1.53）和Cox-2抑制剂（HR 1.61）的风险升高。终末期肾病（ESRD）的发病率很低且无统计学意义。
NSAIDs会增加老年人患CKD的风险并加速肾功能下降。建议谨慎开药并定期进行肾脏监测，还需要进一步的随机试验。
