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Acetaminophen Linked to
Decline in Renal Function
posted August 5, 2004
Higher lifetime use of aspirin
and NSAIDs is not associated with renal function decline, but high acetaminophen
use may increase the risk of loss of renal function.
Lifetime use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) did not
cause a decline in renal function, but acetaminophen slightly increased risk.
Analgesics are commonly used and may impair kidney function," write Gary C.
Curhan, MD, ScD, from Harvard Medical School in Boston, Massachusetts, and
colleagues. "However, limited prospective information is available on the
long-term effects of aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs),
and acetaminophen on renal function."
A total of 1,697 women enrolled in the Nurses' Health Study completed a
questionnaire in 1999 about lifetime use of acetaminophen, aspirin, and NSAIDs
and provided blood samples in 1989 and 2000. Multivariate logistic regression
was used to determine the odds of developing the main outcome of change in
estimated glomerular filtration rate (GFR) for 11 years, based on lifetime
Mean estimated GFR decreased from 88 + 17 mL/minute per 1.73 m2 in 1989 to 79 +
17 mL/minute per 1.73 m2 in 2000. At baseline or after 11 years, there were no
substantial differences in the unadjusted or estimated GFR levels among the
categories of lifetime intake for the three analgesic groups.
Aspirin and NSAID use were not associated with an increased risk of GFR decline.
However, acetaminophen use was associated with an increased risk of GFR decline
of at least 30 mL/minute per 1.73 m2 (P for trend = .01) and of a GFR decline of
30% or more (P for trend < .001). For women consuming more than 3,000 g of
acetaminophen, multivariate-adjusted odds ratio for a decline in GFR of at least
30 mL/minute per 1.73 m2 was 2.04 (95% confidence interval, 1.28 to 3.24)
compared with women consuming less than 100 g.
"Higher lifetime use of aspirin and NSAIDs is not associated with renal function
decline, but high acetaminophen use may increase the risk of loss of renal
function," the authors write. "The absolute risk of renal function decline due
to even high lifetime analgesic intake seems to be modest."
Study limitations include inability to validate self-reported analgesic use,
lack of information on the time of use for lifetime number of tablets before the
first blood-sample collection, follow-up too short to assess the long-term
impact of analgesic use, too few women with substantially reduced renal function
to determine whether preexisting renal disease is required for an adverse impact
of analgesics, lack of information on the indication for analgesic use in the
past, and choice of formula for GFR affecting the interpretation of the results.
"Each of these analgesics has other potential adverse effects that should be
considered when deciding whether an analgesic is needed and which one to use,"
the authors write. "Future studies should address whether these analgesics
affect the rate of decline of renal function in individuals with established
Source: Diabetes In Control.com: Arch
Intern Med. 2004;164:1519-1524 The National Institutes of Health supported this
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