Can NSAIDs for Pain Harm Your Kidneys?

Have you taken nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac, ibuprofen or naproxen? These pain relievers are very popular. In fact, you can buy ibuprofen and naproxen without a prescription. Many people assume that such over-the-counter drugs are quite safe. Can you get into trouble taking NSAIDs for pain?

Too Much Ibuprofen Linked to Kidney Disease:

Q. I have chronic kidney disease, probably from extended use of ibuprofen. Since discontinuing its use, my labs have improved but the damage has been done. I’m left with few analgesic or anti-inflammatory options. Is a topical NSAID safer?

A. You are not alone in experiencing kidney injury due to use of a medication. Nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen could cause chronic kidney disease.

In fact, an article in the Archives of Gerontology and Geriatrics (Aug. 2024) suggests that:

“Because of the widespread use of NSAIDs, it is estimated that between 500,000 and 2.5 million Americans suffer from kidney damage due to NSAID use each year.”

The researchers point out that blood pressure medicines such as lisinopril, losartan or hydrochlorothiazide heighten the risk for kidney injury if people are also taking NSAIDs.

As a result, people with kidney disease may have trouble finding ways to ease their pain. Nondrug approaches would be the first choice. To be successful, you may need to consult a healthcare provider with experience in many different methods of treating pain. You could also ask your doctor if a topical NSAID such as Voltaren gel might occasionally be safe. You wouldn’t want to rely on it often, however, since this NSAID can be absorbed through the skin. Some people develop side effects, although they are less common with topical medicine than with pills (Drugs & Aging, Feb. 2021).

Natural approaches such as sensible exercise, acupuncture, bromelain from pineapple, turmeric, tart cherry juice, grape juice with pectin or gelatin may offer some people relief without endangering their kidneys or their hearts. You can learn more about such options in our eGuide to Alternatives for Arthritis.

Thanks to Dr. Chitra Shankar for assistance with this answer.

Studying NSAIDs for Pain Relief:

Several years ago, a study of soldiers showed that people taking high doses of NSAIDs for pain may develop kidney problems (Nelson et al, JAMA Network Open, Feb. 15, 2019). This was not the first hint of such a link, though. Previous studies had shown that using NSAIDs for pain can increase biomarkers of kidney damage. Some of those studies focused on older adults, who are at higher risk. However, at least one meta-analysis also found problems among younger people.

The JAMA Network Open study used de-identified medical records of more than 750,000 active duty US Army soldiers. Consequently, these were active young and middle-aged adults. The study included records from 2011 through 2014. During that time, nearly 18 percent of these soldiers got a prescription for one to 7 doses of an NSAID pain reliever in a month. Another 16 percent were prescribed more than 7 doses in a month.

Consequences of Taking NSAIDs for Pain:

Fewer than 1 percent of these people were subsequently diagnosed with acute or chronic kidney disease. Nevertheless, the rate of kidney trouble was about 20 percent higher among people who had received high-dose NSAIDs than among those who had taken none. The absolute risk of acute kidney injury was 3 in 1,000. Additionally, the absolute risk of chronic kidney disease was only slightly lower, at 2 in 1,000. These healthy, active young people should have little likelihood of kidney disease. The authors describe this increased risk as modest but statistically significant.

They state:

“In this study we identified modest but statistically significant associations between the highest level of dispensed NSAIDs and incident AKI and CKD in a large military population. Specifically, the adjusted hazard of each outcome was approximately 20% higher among participants who received more than 7 total NSAID DDDs per month compared with those who did not receive prescription NSAIDs.”

Readers aware of this link are anxious to find alternatives to NSAIDs to ease pain.

Can You Ease Joint Pain with Natural Alternatives?

Q. I had a close relative who self-medicated his joint pain with naproxen for many years. Eventually, that ruined his kidneys and he ended up on dialysis.

I do not want to take that risk. What natural remedies can help ease arthritis now that I am suffering from both knee and hip pain?

A. Besides several home remedies such as Certo and grape juice, gin-soaked raisins and Knox Gelatin, there are many herbs and dietary supplements that can relieve inflammation. They include turmeric or its active compound curcumin, ginger, Boswellia, ashwagandha, MSM and SAMe. You can learn more about these options in either our eGuide to Alternatives for Arthritis (an online resource) or our 104-page booklet, The Graedons’ Guide to Alternatives for Arthritis.

A Word of Caution:

Scientists have devoted less attention to studying botanicals such as turmeric than to pharmaceuticals. While turmeric does not appear to be associated with kidney injury, in rare cases it can damage the liver (LiverTox, May 11, 2021). We urge readers to check with their physician or pharmacist regarding possible herb-drug interactions. Turmeric, for example, appears to interact with oral anticoagulants, especially warfarin, to increase the risk for bleeding. In addition, people can develop allergies to supplements just as they do to drugs.