Nonsteroidal Anti-inflammatory Drugs Can Injure Your Kidneys

When I awaken and first get out of bed, I feel my seventy-one years of age.  Decades of weight bearing exercise including running, jogging and walking, in addition to basketball and tennis on hard surfaces, has contributed to wear and tear arthritic discomfort.  I think all the time about popping naproxen, ibuprofen or some other medicine for pain but the risk of an adverse event results in me sucking it up and working through it. 

These wonderful pain medications work by inhibiting prostaglandins involved in the inflammatory response. One of those prostaglandins also keeps the coronary arteries open. The NSAIDS can inhibit the mucous covering of the stomach leading to stomach inflammation and bleeding. 

As a physician caring for senior adults these incredible pain killers can injure the kidneys. By the time we reach 70 years of age most of us have naturally lost 70% of our functioning kidney cells. We do very well with the remaining 25% if we do not stress the kidney asking it to call on reserves it no longer possesses.

A study on the kidney effects of these drugs was published in the Clinical Journal of the American Society of Nephrology in April 2021 by physicians working in Hong Kong. They performed a retrospective analysis of kidney function in almost 2 million Chinese individuals in Hong Kong – all over 18 and with normal kidney function. The study looked at those individuals with a prescription for a NSAID for a minimum of 28 days and found a marked decrease in their Glomerular Filtration Rate (GFR) and a 94% increased risk of a decline of GFR of 30% or greater.

The study looked at ibuprofen, celecoxib, diclofenac, indomethacin, naproxen, piroxicam, sulindac and mefenamic acid. The average patient was 55 years old and 53% were women.  Their results showed that ibuprofen was the least likely to lower GFR indicating kidney injury but even it conferred a risk of 12% on GFR declining to less than 60%.

The findings of this study reinforce what we already know. A steady diet of NSAIDs will injure your kidneys.  An occasional dosage is probably still safe if you take it with food in your stomach and remain well hydrated.

We live in a society where physical exercise and activity are encouraged for health.  Long-term activity will lead to morning stiffness and aches and pains. Traditional opioid pain medications are addictive and clearly not the answer. NSAIDs were hoped to be safer but apparently not so on a long-term steady basis.

Sugary Drinks & Increased Colon Cancer

The Nurses Health Study II followed 95,464 nurses’ health from 1991- 2015. Principal researcher Yin Cao, ScD, MPH, of Washington University in St. Louis and co-researchers found that those women consuming two sugar sweetened beverages a day in adulthood had more than double the early onset colorectal cancer risk as those consuming less than one serving a week. The risk rose by 16% with each additional serving per day.

In adolescents aged 13-18, each serving per day increment was accompanied by a 32 % higher risk of early onset colorectal cancer. As adolescents reach adulthood, replacing these sugar sweetened beverages with artificially sweetened beverages, coffee or milk was associated with a 17-36% lower risk.

The diagnosis of colorectal cancer in those born around 1990, and risk of developing it, is twice as much risk of developing colon cancer and four times the risk of developing rectal cancer as in adults born around 1950. Cao and associates offered several theoretical reasons for the findings including the use of fructose corn syrup as a sweetener instead of real sugar. Fructose corn syrup is known to make changes to the intestinal wall making it more susceptible to carcinogens. And, it has been shown to cause intestinal tumors in mice.

The message is clear. Obstetricians, family practitioners, pediatricians and internists need to start asking about sugar sweetened beverages in our patient histories. Screening for colon and rectal cancer at a younger age with fecal globulin tests, Cologuard fecal genetic testing and fiber optic exams in a younger group is essential. Most importantly, we must educate teenagers and young adults about the dangers of these sugar sweetened beverages so they don’t give them to their friends and eventually their own children.