Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been known to cause renal dysfunction in healthy patients and more pronounced renal effects in patients with cirrhosis and ascites. The use of NSAIDs have been associated with hepatorenal syndrome, a serious and often fatal complication associated with acute decline in renal function in the context of cirrhosis. However, renal safety of selective cyclo-oxygenase-2 (COX-2) and non-selective COX inhibitors has not been well delineated in current research with regards to patients with cirrhosis. This literature review seeks to compare the renal safety of selective and non-selective COX inhibitors in patients with cirrhosis.
Methods: A thorough multi-database search was conducted using various combinations of keywords. Each study was evaluated using the Grading of Recommendations, Assessments, Development and Evaluation (GRADE) system.
Results: Selective COX-2 inhibitor did not produce statistically significant decrements in renal function, whereas short-term use of non-selective COX inhibitors (or NSAIDs) produced significant decreases in GFR, creatinine clearance, prostaglandin E2 levels, platelet aggregation and concurrent furosemide diuresis. However, these adverse renal effects are also largely reversible upon cessation of NSAID use.
Conclusion: Selective COX-2 inhibitors comparatively caused less renal dysfunction and interference with platelet function and diuretic therapy than non-selective COX inhibitors and may be safer in patients with cirrhosis.
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