NSAIDs and Kidney Damage: Who Is at Risk?

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and diclofenac are among the most commonly used medications worldwide. While effective for pain and inflammation, they can cause acute kidney injury (AKI) and worsen chronic kidney disease (CKD).

How NSAIDs Harm the Kidneys

NSAIDs reduce blood flow to the kidneys by inhibiting prostaglandins—chemicals that help keep kidney blood vessels open. In healthy people, this is usually harmless. In susceptible individuals, it can trigger reduced kidney function, fluid retention, and electrolyte imbalances.

Who Is at Highest Risk?

• People with pre-existing chronic kidney disease
• Older adults (age 65+)
• Those taking ACE inhibitors, ARBs, or diuretics
• People with dehydration, heart failure, or liver disease
• Individuals using high-dose or multiple NSAIDs

Warning Signs of Kidney Injury

• Decreased urine output
• Swelling in legs, ankles, or face
• Fatigue or confusion
• Nausea or loss of appetite
• Shortness of breath

Safer Alternatives

For people with kidney disease, acetaminophen (paracetamol) is generally preferred for pain relief. Topical NSAIDs may have lower systemic risk. Always discuss alternatives with a healthcare provider.

Check your risk with our NSAID renal risk calculator.