ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO0028

Nonsteroidal Anti-Inflammatory Drugs and Risk of Acute Adverse Renal Outcomes in Diabetes

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Abdul Kadir, Hanis Binte, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Choo Chon Jun, Jason, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Ang, Teck Wee Andrew, SingHealth Polyclinics, Singapore, Singapore
  • Bee, Yong Mong, Singapore General Hospital, Singapore, SG, Singapore, Singapore
  • Tan, Ngiap chuan, SingHealth Polyclinics, Singapore, Singapore

Individuals with diabetes mellitus (DM) may be susceptible to non-steroidal anti-inflammatory drug (NSAID) –induced acute kidney injury (AKI). However, data on their risk of NSAID-related adverse renal events is sparse. We aimed to evaluate the risk and factors for acute kidney injury and/or hyperkalemia after NSAID prescription to individuals with DM.


Retrospective cohort study of individuals ≥21 years with DM who received prescriptions between 1st July 2015 and 30th December 2017 from the largest tertiary hospital and a major public primary care institution in Singapore.

Laboratory, hospitalization and medication data from 6 months before until 30 days after first prescription were retrieved from electronic medical records. Individuals prescribed systemic NSAID >14 days were identified as the “NSAID” group. We excluded those with systemic NSAID in the preceding 6 months, missing laboratory values, or had baseline estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2.

The outcome was the incidence of AKI (serum creatinine increased >50%) and/ or hyperkalemia (serum potassium >5.5 mmol/L) within 30 days after prescription.


We studied 3896 individuals (mean age 64.5 ± 13.3 years) with incident prescriptions: 138 in the NSAID group and 3758 in the non-NSAID group.

30-day AKI and/or hyperkalemia occurred in 525 individuals (13.5%). After adjusting for age, gender, ethnicity, baseline CVD, eGFR, serum potassium, NSAID, RAAS blocker and diuretic, baseline CVD (adjusted OR 1.41, 95% CI 1.03-1.93, p=0.03), RAAS blocker (adjusted OR 1.42, 95% CI 1.15-1.75, p=0.001), diuretic (adjusted OR 1.91, 95% CI 1.53-2.38, p<0.001) and higher baseline serum potassium (adjusted OR 1.36, 95% CI 1.19-1.57, p<0.001) were independent predictors for the outcome.

NSAID prescription for >14 days was associated with a higher 30-day risk of AKI and/or hyperkalemia (adjusted OR 1.62, 95% CI 0.99 – 2.65, p=0.05). However, the risk of AKI and/or hyperkalemia was markedly increased if NSAID was prescribed concurrently with RAAS blocker (adjusted OR 4.17, 95% CI 1.74–9.98, p=0.001) or diuretic (adjusted OR 3.31, 95% CI 1.09-10.08, p=0.04).


NSAID prescription in individuals with DM may be associated with higher 30-day risk of AKI and/or hyperkalemia, especially with concurrent RAAS blocker or diuretic.


  • Private Foundation Support