The Effects of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) on Postoperative Renal Function: A Meta-Analysis

Abstract

The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function. Eight randomized placebo-controlled double-blinded trials (n=345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95%CI) were calculated by a weighted mean difference analysis using a random-effects model. The NSAIDs (diclofenac, ketorolac, indomethacin, ibuprofen) were used for up to three days after surgery. There were no reported cases of postoperative renal failure requiring dialysis. NSAIDs reduced creatinine clearance by 22 ml.min⁻¹ (95%CI: 7 to 37), sodium output by 54 mmol.day⁻¹ (95%CI: 5 to 103) and potassium output by 38 mmol.day⁻¹ (95%CI: 19 to 56) on Day 1 but not on Day 2. Serum creatinine increased on Day 2 by 15μmol.l⁻¹ (95%CI: 2 to 28). Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.