Kidney Research and Clinical Practice 2020 Mar; 39(1): 81-92  
Acetaminophen use and risk of renal impairment: A systematic review and meta-analysis
Sukrit Kanchanasurakit1,2 , Aimusa Arsu1 , Wuttikorn Siriplabpla3 , Acharaporn Duangjai4-6 , Surasak Saokaew1,5-9
1Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
2Department of Pharmacy, Phrae Hospital, Phrae, Thailand
3Department of Medicine, Phrae Hospital, Phrae, Thailand
4School of Medical Sciences, University of Phayao, Phayao, Thailand
5Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
6Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
7Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
8Biofunctional Molecule Exploratory Research Group, Biomedicine Research Advancement Centre, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
9Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
Correspondence to: Surasak Saokaew
Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, 19 Moo 2 T.Maeka, Muang, Phayao 56000, Thailand. E-mail: surasak.sa@up.ac.th

Edited by Sejoong Kim, Seoul National University, Seongnam, Korea
Received: October 5, 2019; Revised: January 20, 2020; Accepted: January 29, 2020; Published online: March 31, 2020.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Acetaminophen is commonly used for the relief of pain and fever. Advocacy organizations recommend acetaminophen as the drug of choice in patients with kidney disease. Although some studies have suggested a risk of renal impairment after the use of acetaminophen, the effect of acetaminophen on the risk of renal impairment is unclear. The purpose of this research was to demonstrate any correlation linking acetaminophen treatment and renal impairment.
Methods: We performed a systematic review and meta-analysis of the association between acetaminophen and renal impairment in adults by searching Cochrane Library, PubMed, and Embase databases from initiation to June 16, 2019.
Results: Of 13,097 articles identified, 5 studies (2 cohort studies and 3 case-control studies) with a total of 13,114 participants were included. In the random-effects meta-analysis of the cohort study, acetaminophen use was shown to have statistically significant effects on the increased risk of renal impairment (adjusted odds ratio 1.23; 95% confidence interval, 1.07-1.40). The results of sensitivity and subgroup analyses also suggested that acetaminophen use increases the risk of renal impairment. The Egger’s test (P = 0.607) and Begg’s test (P = 0.732) revealed no apparent publication bias.
Conclusion: Acetaminophen is associated with a significantly increased risk of newly developing renal impairment in adults. Physicians who prescribe acetaminophen should be aware of potential adverse renal effects. A longitudinal study that further explores this association is warranted.
Keywords: Acetaminophen, Acute kidney injury, Kidney disease, Renal insufficiency


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