American Journal of Medicine Open · Published 2025-09-27 · DOI 10.1016/j.ajmo.2025.100119
Objective: To assess the risk of hospital-acquired acute kidney injury after nonsteroidal anti-inflammatory drug (NSAID) administration in the general medical population. Methods: This was a retrospective cohort study conducted at an academic medical center (Mayo Clinic, Rochester, MN) that included all general care medical patients for 2 years. Patients were analyzed in a propensity-adjusted approach using inverse probability of treatment weighting (IPTW) according to NSAID exposure on hospital day 0 or 1 categorized as follows: (1) no NSAID exposure; (2) only low-dose aspirin; (3) topical exposures, or (4) systemic NSAIDs. Results: A total of 17,885 patients met the initial inclusion criteria, and 11,840 were included in the study. The systemic NSAID cohort were the healthiest and youngest patients at baseline with fewer comorbidities. After adjustment, there was no significant difference seen in the rate of AKI (using the inverse probability of treatment weighting) between cohorts. The odds ratio of hospital-acquired AKI was 1.16 (0.80-1.70) in the Low-dose Aspirin group, 0.65 (0.21-2.03) in the Topical group, and 0.82 (0.27-1.85) in the Systemic NSAID group, with the No NSAID serving as the reference. Adjusted AKI incidence was 3.4% with No NSAIDs, 3.9% with Low-dose Aspirin, 2.2% with Topicals, and 2.8% with Systemic NSAIDs. These differences were not statistically significant. Conclusion: This study provides evidence that carefully selected hospitalized patients may be able to receive NSAIDs without increasing their AKI risk. This increases options for the treatment of pain, which may improve patient satisfaction and decrease opioid-related complications. Further prospective research is required to verify the findings of our study.
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