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Acetaminophen Use Associated with Decreased Renal Function

In an observational study, renal toxicity was more pronounced in older women with estimated lifetime acetaminophen intakes of 3000 g.

Non-narcotic analgesics are thought to be associated with renal toxicity, but distinctions in risk among acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs are unclear. Researchers assessed the renal effects of these three analgesic classes in 1697 women (mean age, 57) who were participating in the Nurses' Health Study and who had provided blood samples in 1989 and in 2000.

Information on lifetime use of non-narcotic analgesics was collected retrospectively by questionnaire in 1999 and was used to estimate lifetime intake. Mean estimated glomerular filtration rate (GFR) declined from 88 to 79 mL/min/1.73 m². In multivariate analysis, only acetaminophen was associated with a mean decline in GFR of at least 30%. Odds ratios for a 30% decline in GFR increased from 1.4 for women with estimated lifetime acetaminophen intakes of 100-499 g to 2.19 for women with estimated lifetime intakes of 3000 g (compared with odds for women who had estimated lifetime intakes of <100 g).

Comment: Although these results are limited by recall bias for both the amount and type of analgesics used, and by the use of estimated GFR, these factors should not have bolstered the reported association with acetaminophen only. Considering these data and other known risks of non-narcotic analgesic use, physicians should advise patients to use all such drugs parsimoniously.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine August 3, 2004

Citation(s):

Curhan GC et al. Lifetime nonnarcotic analgesic use and decline in renal function in women. Arch Intern Med 2004 Jul 26; 164:1519-24.

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