Choosing Wisely:

Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) in individuals with hypertension or heart failure or chronic kidney disease of all causes, including diabetes.

Rationale and Comments: The use of NSAIDs, including cyclooxygenase type 2 inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate blood pressure, make antihypertensive drugs less effective, cause fluid retention, and worsen kidney function in these individuals. Other agents such as acetaminophen or tramadol, or short-term use of narcotic analgesics, may be safer than and as effective as NSAIDs.
Sponsoring Organizations:
  • American Society of Nephrology
  • Sources:
  • National Kidney Foundation Kidney Disease Outcomes Quality Initiative
  • Disciplines:
  • Nephrologic
  • Cardiovascular
  • References: • National Kidney Foundation Kidney Disease Outcomes Quality Initiative. KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. http://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm.
    • Chronic kidney disease in adults: UK guidelines for identification, management and referral. http://www.renal.org/ ckdguide/full/ukckdfull.pdf.
    • Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf.
    • Scottish Intercollegiate Guidelines Network. Management of chronic heart failure. http://www.sign.ac.uk/pdf/sign95.pdf.

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