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) 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
The patient's eGFR of 41 indicates impaired renal function, but it does not specify the exact creatinine clearance. However, an eGFR of 41 is generally considered to indicate moderate renal impairment.
- Naproxen is primarily excreted by the kidney, and its elimination is decreased in patients with severe renal impairment.
- The label states that naproxen-containing products are not recommended for use in patients with moderate to severe and severe renal impairment. Based on this information, it is recommended to avoid using naproxen in a patient with an eGFR of 41, as it may indicate moderate renal impairment. 1
From the Research
Naproxen should be used with extreme caution in a patient with chronic kidney disease (CKD) and an eGFR of 41 mL/min/1.73m², as it can worsen kidney function and lead to acute kidney injury, further decline in eGFR, fluid retention, and worsening hypertension. The use of naproxen in patients with CKD is a concern due to its potential to reduce renal blood flow through inhibition of prostaglandin synthesis, which normally helps maintain kidney perfusion 2. A study published in 2016 found that selective COX-2 inhibitors, a class of NSAIDs that includes naproxen, were associated with a significant decline in eGFR and increased risk of hyperkalemia in CKD patients 2. Another study published in 2012 found that serum creatinine remained a significant predictor of NSAID/COX-2 prescription, even in patients with mild to moderate CKD 3.
Given the potential risks, alternative pain management options such as acetaminophen, topical NSAIDs, or short-term low-dose opioids may be safer choices for patients with CKD. If naproxen must be used, it should be at the lowest effective dose for the shortest duration possible, with close monitoring of kidney function. Kidney function should be reassessed within 1-2 weeks of starting therapy, and the patient should be monitored for signs of fluid retention, worsening hypertension, or declining kidney function. A more recent study published in 2022 highlights the importance of careful management of patients with CKD and heart failure, emphasizing the need for close monitoring of renal function and adjustment of medication dosages accordingly 4.
In the context of CKD, the risk of worsening renal function and its impact on outcomes is a significant concern, as highlighted in a study published in 2018 5. Therefore, the use of naproxen in patients with CKD should be approached with caution, and alternative treatment options should be considered whenever possible.