PC2074: Acute Kidney Injury Following Ibuprofen Use in Children During COVID-19

Background: Ibuprofen is one of the most widely used non-steroidal anti-inflammatory drug (NSAID) that is easily accessible as an over-the-counter medication.[1] Acute Kidney Injury (AKI), which is a known potential adverse effect of NSAID use, has been previously proposed as a complication of COVID-19 infection.[1-3] We sought to investigate AKI occurrences in children following the use of ibuprofen using the US FDA Adverse Event Reporting System (FAERS) database over 11 years (2010-2021), including the years of the pandemic, in children 17 years old and younger.

Methods: Pediatric reports of AKI were calculated per year and compared with chi-square analysis; significance was defined as p< 0.05. Reporting Odds Ratio (RORs) and relative risk (RR), with corresponding 95% confidence interval (CI) upper limit (UP) and lower limit (LL), were calculated. The ROR was calculated as the odds that a report did or did not list AKI for ibuprofen compared with the same odds for all reports not mentioning ibuprofen.[4]

Results: 171 cases of AKI were identified. There was a significant increase in cases in 2021 compared to 2010 (p < 0.001), 2015 (p < 0.001), and 2018 (p < 0.001). There was a significant increase in cases of AKI following ibuprofen use before the pandemic (2019) compared to during the pandemic (2020) (p < 0.001). Furthermore, there was a significant decrease in cases of AKI following ibuprofen use from 2020 to 2021 (p < 0.005). Total ROR (95% CI LL, UP) was calculated to be 8.34 (7.19, 9.66) and RR (95% CI LL, UP) was calculated to be 8.065 (7.01, 9.28). In 2021, the reported reason for use included pain (38%), intentional overdose (16%), and pyrexia (3%). The ages most affected were between 14 to 17 years old (Table 1).

Conclusion: There was a significant rise in ibuprofen-associated AKI from 2010 to 2021, with significant increases in 2020 (Figure 1). We found that 14 to 17-year-olds revealed an increase in ibuprofen-associated AKI over younger age groups. Notably, in 2021, we found that 15 to 17-year-olds accounted for 97% of cases. The reported indications for use in 2021 included pain (38%) and intentional overdose (16%).
Further investigations are necessary to understand the role that SARS-CoV-2 may have had on the increase of cases in 2020, especially with the following decrease in cases in 2021 regressing back to the expected trend (Figure 1). This decrease in ibuprofen-associated AKI cases in 2021, may be due to decreased rates of SARS-CoV-2 infections, increased vaccination, or better management as health professionals became more knowledgeable on the virus. While we cannot identify the possible effects COVID-19 may have had on our findings, there is a significant rise in AKI cases. These findings suggest that caution should be advised in the use of ibuprofen in the pediatric population.