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Henrich WL, Agodoa LE, Barrett B, Bennett WM, Blantz RC, Buckalew VM, et al.

Analgesics and the kidney: Summary and recommendations to the Scientific Advisory Board of the NKF from an Ad Hoc Committee of the NKF

Am J Kidney Dis (Jan) 27:162-164 1996

Recommendations of the National Kidney Foundation on Analgesics and the Kidney

On June 9 to 11, 1995, the National Kidney Foundation convened an expert group of investigators and clinicians to consider and develop recommendations on the issue of analgesic-related kidney disease. The following recommendations were published in the January 1996 issue of the American Journal of Kidney Disease.

Aspirin as a single analgesic.

  • In patients with normal renal function, aspirin should not be taken within 48 hours of ingestion of any nonnarcotic NSAID, and vice versa.
  • In patients with impaired renal function, acute glomerulonephritis, sodium depletion, cirrhosis with ascites, and in children with congestive heart failure, aspirin should be avoided. If use is necessary, careful monitoring of renal function should be undertaken. This would consist, at the least, of following the serum creatinine concentration at baseline and regular intervals.

Acetaminophen as a single analgesic.
  • Acetaminophen remains the nonnarcotic analgesic of choice for episodic use in patients with underlying renal disease.
  • The habitual consumption of acetaminophen should be discouraged.

Aspirin/Acetaminophen Combinations.
  • The availability of analgesic mixtures as an over-the-counter produce should cease.
  • Analgesic mixtures as prescription products should have a label warning of the increased prevalence of kidney injury and chronic renal failure associated with habitual use of analgesic mixtures.

  • There should be an explicit label warning patients taking over-the- counter NSAIDs of the potential renal risks of consuming the drugs.
  • The use of NSAIDs during pregnancy should be avoided.
  • The prolonged regular use of NSAIDs should be discouraged.
  • Combinations of NSAIDs with other analgesics or caffeine should be prospectively evaluated for renal safety before the release of any such combination.

(George R. Aronoff, M.D.)