Abstract: TH-OR048
Nonsteroidal Anti-Inflammatory Drug Use and Kidney Tubule Damage Among Persons with CKD: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Zhang, Angel W., University of California San Francisco, San Francisco, California, United States
- Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States
- Grunfeld, Carl, University of California San Francisco, San Francisco, California, United States
- Brown, Julia, University of Illinois Chicago, Chicago, Illinois, United States
- Chen, Jing, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Dobre, Mirela A., UH Cleveland Medical Center, Cleveland, Ohio, United States
- Gensler, Lianne, University of California San Francisco, San Francisco, California, United States
- Hamm, L. Lee, Tulane University, New Orleans, Louisiana, United States
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
- Rao, Panduranga S., University of Michigan, Ann Arbor, Michigan, United States
- Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Sondheimer, James H., Wayne State University, Detroit, Michigan, United States
- Taliercio, Jonathan J., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Weir, Matthew R., University of Maryland, College Park, Maryland, United States
- Yang, Wei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
- Shlipak, Michael G., University of California San Francisco, San Francisco, California, United States
Background
In CKD, prior studies have reported conflicting conclusions regarding the nephrotoxic risk of nonsteroidal anti-inflammatory drugs (NSAIDs), and the specific sites of kidney damage have not been well characterized. We hypothesize that known biomarkers will be able to identify the locations impacted by NSAID exposure.
Methods
In CRIC, 820 participants self-reported NSAID initation during study follow-up. We measured 13 biomarkers reflective of kidney glomerular and tubular health in urine and blood specimens collected pre-NSAID initiation and during NSAID exposure. Using multivariable adjusted linear mixed effects models, we examined the association between initiating NSAIDs and changes in concentrations of glomerular and tubular health markers. Estimates were weighted to account for inverse probability of censoring due to dropout and inverse probability of treatment.
Results
The median age at baseline was 60 years, 42% were female, and 43% of participants self-identified as non-Hispanic Black; median (IQR) eGFR was 49 (33-65) ml/min/1.73m2 and urine ACR was 84 (17-693) mg/g. Following NSAID initiation, we observed significant elevations in the concentrations of markers reflective of worsening tubular health. The strongest associations were observed for urine markers of tubule injury (uIL-18, uKIM-1, uMCP-1, uYKL-40) and reabsorption dysfunction (uα1m, uβ2m). No significant association was observed for eGFR or urine ACR.
Conclusion
In persons with CKD, initiating NSAIDs was associated with elevations in markers of proximal tubule injury and proximal tubule reabsorption dysfunction. These biomarkers show promise for early detection of nephrotoxicity in NSAID users.
Funding
- NIDDK Support