Practice Pearls: NSAIDs (Painkillers) and CKD

People with chronic kidney disease (CKD) are generally advised not to take nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen), with the exception of aspirin for cardiovascular indications.

NSAIDs have been associated with acute kidney injury in the general population and with progression of disease in those with CKD. NSAIDs may also decrease the effectiveness of certain medications, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) that are often used by people with kidney disease to lower their blood pressure and protect their kidney function.

Practice Pearls for Healthcare Providers

  • Be aware of all current medications and the CKD status of your patients.
  • Ask your patients whether they use over-the-counter NSAIDs.
  • Make sure your patients with CKD know that over-the-counter NSAIDs can damage kidneys, especially if taken with ACEIs or ARBs.

If you prescribe medicine for pain management

  • Be aware of the nephrotoxicity and potential interactions of NSAIDs, including over-the-counter NSAIDs—with ACEIs, ARBs, and loop diuretics.
  • Take an individual approach, weighing improvement of quality of life with NSAID use against the potential risk for kidney disease progression and further kidney damage.
  • Discuss the risks of NSAID use not only with patients who already have kidney disease but also with those who take NSAIDs regularly but do not have CKD.

For more information

Are you aware? About 9% of patients with moderate to severe chronic kidney disease use prescription NSAIDs.

Plantinga L, Grubbs V, Sarkar U, et al. Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States. pdf icon[PDF – 332K]external icon Ann Fam Med. 2011;9(5):423–430.

Page last reviewed: August 5, 2021