Avoid the use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients suffering from hypertension, cardiac insufficiency or chronic kidney disease – whatever their cause (including diabetes).

Type of practice


Topic Area


Numerous drugs can cause renal insufficiency, or facilitate its progression, so they should be used with particular caution. The so-called NSAIDs (non-steroidal anti-inflammatory drugs) are the most often used painkillers (e.g. nimesulide, ketoprofen, diclofenac, ibuprofen, naproxen, piroxicam, ketorolac, meloxicam – sold under various trade names). These drugs can cause damage by reducing the inflow of blood to the kidney, or by interfering with the arachidonic acid, prostaglandin and prostacyclin systems. The end-result is a reduction in the blood flow to the glomeruli, with a consequent decline in glomerular filtration, and an increase in creatinine and blood nitrogen levels, and arterial blood pressure. This condition may even be irreversible. It can be important in patients with chronic kidney disease (CKD), who have a more limited functioning nephron mass, and vessel constriction due to hyperfiltration; and it is particularly important for diabetic patients with CKD, who already have a tendency for vessel constriction, which is exacerbated by the use of NSAIDs.


1. Nonsteroidal anti-inflammatory drugs and their risk: a story still in development. Simon LS. Arthritis Res Ther 2013; 15 Suppl 3: S1.
2. Inappropriate use of nonsteroidal anti-inflammatory drugs and other drugs inchronic kidney disease patients without renal replacement therapy. Bilge U, Sahin G, Unluoglu I, Ipek M, Durdu M, Keskin A.Ren Fail 2013 Jul; 35(6): 906-10.
3. Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review. Nderitu P, Doos L, Jones PW, Davies SJ, Kadam UT. Fam Pract 2013 Jun; 30(3): 247-55.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.