From the Guidelines
Aleve (naproxen) should be avoided in patients with Chronic Kidney Disease (CKD) due to its potential nephrotoxic effects. According to the KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease 1, people with CKD may be more susceptible to the nephrotoxic effects of medications, and it is essential to consider the benefits versus potential harms when prescribing such medications.
The use of over-the-counter medicines like Aleve (naproxen) can be harmful to people with CKD, as stated in Practice Point 4.1.3 of the guideline 1. Naproxen and other NSAIDs can worsen kidney function in CKD patients by reducing blood flow to the kidneys through inhibition of prostaglandins that normally help maintain kidney perfusion.
Key considerations for CKD patients include:
- Monitoring eGFR, electrolytes, and therapeutic medication levels when receiving medications with narrow therapeutic windows, potential adverse effects, or nephrotoxicity, as recommended in Practice Point 4.1.2 of the guideline 1
- Reviewing and limiting the use of over-the-counter medicines and dietary or herbal remedies that may be harmful, as stated in Practice Point 4.1.3 of the guideline 1
- Avoiding sodium and water retention, which can worsen hypertension and edema that often accompany kidney disease
- Being cautious of potential interactions with medications commonly prescribed to CKD patients, such as ACE inhibitors or ARBs, which can further compromise kidney function.
In patients with CKD, acetaminophen (Tylenol) may be considered as a first-choice over-the-counter pain reliever, at doses of 500-1000 mg every 6 hours, not exceeding 3000 mg daily. However, if pain relief is inadequate, patients should consult their nephrologist or primary care physician for appropriate alternatives.
From the FDA Drug Label
Naproxen-containing products are not recommended for use in patients with moderate to severe and severe renal impairment (creatinine clearance < 30 mL/min) (see WARNINGS: Renal Effects). Given that naproxen, its metabolites and conjugates are primarily excreted by the kidney, the potential exists for naproxen metabolites to accumulate in the presence of renal insufficiency. Elimination of naproxen is decreased in patients with severe renal impairment In patients with renal failure metabolites may accumulate (see WARNINGS: Renal Effects)
The use of Naproxen (Aleve) may have a negative effect on Chronic Kidney Disease (CKD), as it can:
- Accumulate in the presence of renal insufficiency
- Decrease elimination in patients with severe renal impairment
- Increase the risk of adverse effects due to metabolite accumulation It is recommended to avoid using Naproxen in patients with moderate to severe renal impairment. 2
From the Research
Effect of Aleve (Naproxen) on Chronic Kidney Disease (CKD)
- The use of Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (Naproxen), has been associated with an increased risk of nephrotoxicity and worsening of CKD 3, 4, 5.
- Regular NSAID use may be associated with an increased incidence of CKD, but the relation between NSAID use and CKD progression is less clear 4, 6.
- High-dose NSAID use has been shown to significantly increase the risk of accelerated CKD progression, while regular-dose NSAID use did not significantly affect the risk 6.
- The risk of NSAID-induced nephrotoxicity is modified by many comorbid conditions, risk factors, and characteristics of use, and in patients with CKD, the risk differs between levels of glomerular filtration rate 3, 5.
- Patients with CKD should be cautious when using NSAIDs, and the lowest effective dose should be prescribed where indicated 6, 5.
- The main mechanism of NSAID-induced nephrotoxicity is the inhibition of cyclooxygenase (COX) enzyme, which interferes with the conversion of arachidonic acid into prostaglandins, leading to a decrease in renal perfusion 5.