In a previous alert, I told you how regular use of the painkiller ibuprofen can block the cardio-protective effects of your daily aspirin. Based on that, you might think it’s a good idea to switch to another painkiller, like acetaminophen, so you can continue to benefit from aspirin’s blood-thinning effects.
But according to another study in this month’s New England Journal of Medicine, that decision might put you at even more risk.
Regular use of acetaminophen or aspirin DOUBLES risk of kidney failure
In this study, researchers in Sweden polled more than 1,900 people between the ages of 18 and 74 about their use of common prescription and OTC analgesic drugs. And here’s what they found: the people who regularly took acetaminophen or aspirin were two and a half times more likely to have chronic kidney failure as compared to people who did not use those drugs.
The researchers collected data from 918 patients who had recently been diagnosed with renal (kidney) failure and 998 people with healthy kidneys. Through a self-administered questionnaire and face-to-face interviews with impartial interviewers (the interviewers were not aware of the intent of the study), they gathered information on the participants’ lifetime consumption of a variety of analgesic drugs, including aspirin and acetaminophen.
Patients were considered “regular users” if they took the drug at least twice a week for two months at a time. Kidney function was measured by blood levels of creatinine, a waste product of protein metabolism that is usually excreted in the urine. High blood levels of creatinine indicate that the kidneys are failing to clear wastes from the body. In this study, serum creatinine levels were considered high if they were above 3.4 mg per deciliter in men or above 2.8 mg per deciliter in women.
Fifty-one percent of the patients and 29 percent of the controls reported regular use of at least one analgesic. Thirty seven percent of all patients reported regular use of aspirin, compared with 19 percent of controls. One-quarter of all patients reported routine use of acetaminophen, while only 12 percent of controls said they used that drug regularly.
Which came first, the drugs or the disease? Study answers question once and for all
This is not the first time that painkillers have been linked to kidney damage. Years ago, doctors discovered that analgesics containing the drug phenacetin could harm the kidneys. Recently, several studies have shown that analgesic mixtures containing acetaminophen, aspirin, caffeine, or codeine can cause problems. And a few small studies have suggested that even single-ingredient medications containing acetaminophen or aspirin can do harm.
But, according to the NEJM study, the other studies linking acetaminophen and aspirin use with renal failure were small and flawed. Critics of the previous studies suggested that kidney disease might lead people to use painkillers more often, not the other way around.
So the authors of this study set out to test that theory, and avoid the pitfalls of the previous trials. All of the kidney failure patients in this study had just recently been diagnosed – their creatinine levels had just exceeded safe levels for the very first time. This allayed concerns that long-term chronic disease had led to an overall health decline, triggering more painkiller usage. Still, the data showed compelling evidence that aspirin and acetaminophen were associated with kidney disease.
After learning about this study, and the one I told you about on Friday, you may want to re-evaluate your use of NSAIDs. Now we know that even when they do work, the pain relief may come at too great a price. We already knew that regular use of NSAIDs can cause serious gastrointestinal problems. Now in light of this new research, you have to wonder if their benefits are worth all the risks.
But as I mentioned last week, there are other options. Whether you take NSAIDs to relieve pain or to thin your blood – or for both – there are safe, natural alternatives you can try. The one I mentioned on Friday, bromelain is an enzyme found in pineapple that can reduce pain and inflammation AND thin your blood as well – without damaging side effects. (We wrote extensively about bromelain in both the June 1999 and October 1999 Members Alert newsletters.) Bromelain is available in many health food stores, as well as from a company called VitaMedics. You can reach VitaMedics by calling 800-216-2724.
If you’ve been taking aspirin and acetaminophen regularly, ask your doctor to test your serum creatinine levels. And talk to him about other alternatives to manage your pain and protect your heart. You shouldn’t need to risk one area of your health to treat another.
Sources:
N Engl J Med 2001; 345:1801-1808
N Engl J Med 2001; 345:1809-1817
Copyright 1997-2002 by Institute of Health Sciences, L.L.C.
